非手术治疗肠套叠后早期出院既安全又具有成本效益。
Early discharge after nonoperative management of intussusception is both safe and cost-effective.
机构信息
Center for Surgical Trials and Evidence-Based Practice (C-STEP), McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 5.246, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
Center for Surgical Trials and Evidence-Based Practice (C-STEP), McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
出版信息
J Pediatr Surg. 2022 Jan;57(1):147-152. doi: 10.1016/j.jpedsurg.2021.09.047. Epub 2021 Oct 5.
BACKGROUND/PURPOSE: We implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates.
METHODS
A retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P < 0.05 significant.
RESULTS
Of 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1-34.6) versus 9.3 h (IQR 7.4-14.2) for post-QI patients, P < 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442-$4,020) versus $1,861 (95% CI, $1,481-$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]-[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6].
CONCLUSIONS
Implementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions.
LEVEL OF EVIDENCE
Level III.
TYPE OF STUDY
Retrospective comparative treatment study.
背景/目的：我们实施了一项质量改进（QI）计划，以安全地减少小儿回肠套叠患者的复位后监测。我们假设，在不改变肠套叠复发率的情况下，住院时间（LOS）和住院费用会减少。
方法
对 2015 年 1 月至 2020 年 6 月在一家三级儿童医院成功接受肠套叠灌肠复位的小儿回肠套叠患者进行了回顾性队列研究。2017 年 9 月，实施了肠套叠管理方案，允许患者在复位后 4 小时内出院。比较 QI 前后的指数就诊和出院后 24 小时内任何额外就诊的结果。对医院费用进行了经济评估，将通货膨胀调整为 2020 年美元（$）。使用多变量回归评估组间成本差异，调整医疗补助和转移状态，P<0.05 有统计学意义。
结果
90 例患者中，37 例（41%）为 QI 前，53 例（59%）为 QI 后。两组患者的年龄、性别、种族、保险状况和转移状态相似。QI 前患者 LOS 中位数为 23.4 小时（IQR：16.1-34.6），QI 后患者 LOS 中位数为 9.3 小时（IQR：7.4-14.2），P<0.001。QI 前组每位患者的平均总费用为 3231 美元（95%CI，2442-4020），QI 后组为 1861 美元（95%CI，1481-2240）。QI 后组每位患者的平均绝对成本差异为 1370 美元（95%CI，[-2251]-[-490]）。出院后 24 小时内有 5 例患者出现额外就诊[QI 前：1（3%）例 vs QI 后：4（8%）例，p=0.7]，其中 4 例出现肠套叠复发[QI 前：1（3%）例 vs QI 后：3（6%）例，p=0.6]。
结论
为治疗小儿肠套叠而实施的质量改进计划减少了住院时间和费用，而不会对出院后就诊或复发率产生负面影响。类似的方案可以很容易地在其他机构采用。
证据水平
III 级。
研究类型
回顾性比较治疗研究。
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