Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Pediatric Surgery, Department of Surgery, Indiana University, Indianapolis, Indiana.
Pediatrics. 2021 Dec 1;148(6). doi: 10.1542/peds.2020-047464.
To characterize patterns of surgery among pediatric patients during terminal hospitalizations in children's hospitals.
We reviewed patients ≤20 years of age who died among 4 424 886 hospitalizations from January 2013-December 2019 within 49 US children's hospitals in the Pediatric Health Information System database. Surgical procedures, identified by International Classification of Diseases procedure codes, were classified by type and purpose. Descriptive statistics characterized procedures, and hypothesis testing determined if undergoing surgery varied by patient age, race and ethnicity, or the presence of chronic complex conditions (CCCs).
Among 33 693 terminal hospitalizations, the majority (n = 30 440, 90.3%) of children were admitted for nontraumatic causes. Of these children, 15 142 (49.7%) underwent surgery during the hospitalization, with the percentage declining over time (P < .001). When surgical procedures were classified according to likely purpose, the most common were to insert or address hardware or catheters (31%), explore or aid in diagnosis (14%), attempt to rescue patient from mortality (13%), or obtain a biopsy (13%). Specific CCC types were associated with undergoing surgery. Surgery during terminal hospitalization was less likely among Hispanic children (47.8%; P < .001), increasingly less likely as patient age increased, and more so for Black, Asian American, and Hispanic patients compared with white patients (P < .001).
Nearly half of children undergo surgery during their terminal hospitalization, and accordingly, pediatric surgical care is an important aspect of end-of-life care in hospital settings. Differences observed across race and ethnicity categories of patients may reflect different preferences for and access to nonhospital-based palliative, hospice, and end-of-life care.
描述儿童医院临终住院患儿的手术模式。
我们回顾了 2013 年 1 月至 2019 年 12 月期间，49 家美国儿童医院的儿科健康信息系统数据库中 4424866 例住院患者中≤20 岁死亡患者的资料。手术程序通过国际疾病分类手术代码确定，并根据类型和目的进行分类。描述性统计方法描述了手术程序，并通过假设检验确定了手术是否因患者年龄、种族和民族以及是否存在慢性复杂疾病（CCCs）而有所不同。
在 33693 例临终住院患者中，大多数（n=30440，90.3%）儿童因非创伤性原因入院。这些儿童中有 15142 例（49.7%）在住院期间接受了手术，且随着时间的推移，手术比例逐渐下降（P<0.001）。当手术程序根据可能的目的进行分类时，最常见的是植入或处理硬件或导管（31%）、探查或辅助诊断（14%）、试图使患者免于死亡（13%）或获取活检（13%）。特定的 CCC 类型与手术有关。西班牙裔儿童（47.8%；P<0.001）接受手术的可能性较小，随着患者年龄的增长，接受手术的可能性逐渐降低，与白人患者相比，黑人和亚裔以及西班牙裔患者的可能性更低（P<0.001）。
近一半的儿童在临终住院期间接受手术，因此，儿科手术护理是医院环境中临终关怀的重要组成部分。观察到的患者种族和民族差异可能反映了对非住院姑息治疗、临终关怀和临终关怀的不同偏好和获得情况。
