Choi Jonathan S, Yu Justin, Lovin Benjamin D, Chapel Alyssa C, Patel Akash J, Gallagher K Kelly
Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States.
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States.
J Neurol Surg B Skull Base. 2020 Oct 12;83(1):76-81. doi: 10.1055/s-0040-1716676. eCollection 2022 Feb.
The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database. The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients. A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day ( = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, = 0.041). Patients receiving PVE were charged an additional $35,600 ( < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing. PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.
本研究旨在利用全国儿科住院数据库评估术前血管栓塞术（PVE）对青少年鼻咽血管纤维瘤（JNA）手术结果的影响。
查询了1997年至2016年间医疗保健成本和利用项目儿童住院数据库中所有JNA手术治疗病例。根据患者是否接受PVE对病例进行分层。在控制患者人口统计学因素和合并症的同时，使用多元线性回归预测PVE对住院时间（LOS）和总成本的影响。使用二元逻辑回归计算PVE患者围手术期输血的比值比（OR）。
在此期间，共确定了473例接受JNA手术切除的患者。PVE的使用从1997年的0%增加到2016年所有病例的66%。发现PVE可使住院时间缩短1天（P = 0.036），并降低围手术期输血的几率（OR = 0.511，P = 0.041）。接受PVE的患者需额外支付35,600美元（P < 0.001），但2016年的最新数据表明PVE的住院费用正在下降。
JNA的PVE越来越普遍。栓塞可缩短住院时间，降低输血几率。虽然栓塞会增加治疗成本，但随着该手术越来越普及，这一趋势应重新评估。
