全国范围内关于体外膜肺氧合（ECMO）在先天性膈疝中相关的人口统计学和结局的数据库分析。
A nationwide database analysis of demographics and outcomes related to Extracorporeal Membrane Oxygenation (ECMO) in congenital diaphragmatic hernia.
机构信息
University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
Division Chief of Adolescent Obesity Surgery, RWJ Medical School, Rutgers, State University of New Jersey, 504 MEB, 1 RWJ Place, New Brunswick, NJ, 08901, USA.
出版信息
Pediatr Surg Int. 2021 Nov;37(11):1505-1513. doi: 10.1007/s00383-021-04979-y. Epub 2021 Aug 16.
PURPOSE
The aim of the study was to understand the use of Extracorporeal Membrane Oxygenation (ECMO) in congenital diaphragmatic hernia (CDH) and its outcomes.
METHODS
The 2016 Kid's Inpatient Database (KID) obtained from the national Healthcare Cost and Utilization Project (HCUP) was used to obtain CDH birth, demographic, and outcome data associated with ECMO use. Categorical variables were analyzed and odds ratios (OR) with 95% confidence intervals (CI) are reported for variables found to have significance (p < 0.05). Appropriate regressions were used for comparing categorical and continuous data using SPSS 25 for Macintosh.
RESULTS
The database contained 1189 cases of CDH, of which 133 (11.2%) received ECMO. The overall mortality of neonates with CDH was 18.9% (225/1189). Newborns with CDH on ECMO had a survival of 46% (61/133) compared to 85.5% without ECMO (903/1056) (OR 6.966, p < 0.001, 95% CI 4.756-10.204). ECMO increased length of stay from 24.6 to 69.8 days (OR 2.834, p < 0.001, 95% CI 2.768-2.903) and average cost from $375,002.20 to $1641,586.83 (OR 4.378, p < 0.001, 95% CI 3.341-5.735).
CONCLUSIONS
Increased length of stay, costs, and outcomes with ECMO use in CDH should prompt an examination of criteria necessitating ECMO.
目的
本研究旨在了解体外膜肺氧合（ECMO）在先天性膈疝（CDH）中的应用及其结果。
方法
本研究使用了来自国家医疗保健成本和利用项目（HCUP）的 2016 年儿童住院数据库（KID），以获取与 ECMO 使用相关的 CDH 出生、人口统计学和结果数据。分析了分类变量，并报告了具有统计学意义（p<0.05）的变量的比值比（OR）和 95%置信区间（CI）。使用 SPSS 25 for Macintosh 对分类和连续数据进行适当回归。
结果
该数据库包含 1189 例 CDH 病例，其中 133 例（11.2%）接受了 ECMO。CDH 新生儿的总体死亡率为 18.9%（225/1189）。接受 ECMO 的 CDH 新生儿的存活率为 46%（61/133），而未接受 ECMO 的新生儿的存活率为 85.5%（903/1056）（OR 6.966，p<0.001，95%CI 4.756-10.204）。ECMO 使住院时间从 24.6 天延长至 69.8 天（OR 2.834，p<0.001，95%CI 2.768-2.903），平均费用从 375002.20 美元增加至 1641586.83 美元（OR 4.378，p<0.001，95%CI 3.341-5.735）。
结论
CDH 中 ECMO 的使用增加了住院时间、成本和结果，这应该促使我们检查需要 ECMO 的标准。
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