DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America.
DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America.
J Pediatr Surg. 2022 Jun;57(6):1104-1109. doi: 10.1016/j.jpedsurg.2022.01.026. Epub 2022 Jan 31.
This study aims to compare the morbidity of open versus laparoscopic colectomy or proctocolectomy for pediatric patients with ulcerative colitis (UC) using national readmission outcomes.
The 2010-2014 Nationwide Readmissions Database was used to identify patients < 18 years (excluding newborns) who underwent colectomy or proctocolectomy for UC. Patients with planned readmissions for staged procedures were excluded from readmission analysis. Demographics, hospital factors, and outcomes were compared by operative approach (open vs. laparoscopic) using standard statistical analysis. Results were weighted for national estimates.
There were 1922 patients (51% female, age 13 ± 3 years) with UC who underwent colectomy or proctocolectomy during index admission. Most cases were performed open (54%) and as elective admissions (64%). Compared to open approach, laparoscopy was associated with shorter index hospital length of stay (8 [5-17] days vs. 9 [6-18] days, p = 0.015), fewer surgical site infections (< 2% vs. 2%, p = 0.022), and less post-operative gastrointestinal dysfunction (5% vs. 8%, p = 0.008). After stratifying to control for elective and unplanned index admissions, laparoscopic approach was associated with fewer small bowel obstructions during index hospitalizations in both elective (9% vs. 15%, p = 0.003) and unplanned (5% vs. 16%, p<0.001) settings. Readmission for surgical site infection was also less common following laparoscopic approach in both elective (0% vs. 7%, p = 0.008) and unplanned (0% vs. < 7%, p = 0.017) settings.
In pediatric patients with ulcerative colitis, laparoscopic colectomy or proctocolectomy is associated with shorter hospital length of stay, less post-operative complications, and improved readmission outcomes.
本研究旨在利用全国再入院结果比较儿童溃疡性结肠炎（UC）患者开腹与腹腔镜结直肠切除术或直肠结肠切除术的发病率。
使用 2010-2014 年全国再入院数据库，确定<18 岁（不包括新生儿）因 UC 行结直肠切除术或直肠结肠切除术的患者。排除分期手术的计划性再入院患者进行再入院分析。采用标准统计分析方法，比较手术方式（开腹与腹腔镜）的人口统计学、医院因素和结果。结果进行全国估计的加权处理。
1922 例 UC 患者（51%为女性，年龄 13±3 岁）在索引住院期间接受了结直肠切除术或直肠结肠切除术。大多数病例为开放性（54%）和择期手术（64%）。与开腹手术相比，腹腔镜手术与较短的住院时间相关（8[5-17]天比 9[6-18]天，p=0.015）、较少的手术部位感染（<2%比 2%，p=0.022）和较少的术后胃肠道功能障碍（5%比 8%，p=0.008）。在分层以控制择期和非计划性索引入院后，在择期（9%比 15%，p=0.003）和非计划性（5%比 16%，p<0.001）情况下，腹腔镜手术与索引住院期间小肠梗阻减少相关。在择期（0%比 7%，p=0.008）和非计划性（0%比<7%，p=0.017）情况下，腹腔镜手术术后手术部位感染的再入院率也较低。
在患有溃疡性结肠炎的儿科患者中，腹腔镜结直肠切除术或直肠结肠切除术与较短的住院时间、较少的术后并发症和改善的再入院结果相关。
