模式麻醉和管理膀胱后骨科手术在儿童脑瘫：系统水平分析。

Mode of Anesthesia and Bladder Management Following Orthopaedic Surgery in Children With Cerebral Palsy: A System Level Analysis.

机构信息

Shriners Hospitals for Children, Portland, OR.

Wake Forest School of Medicine, Clinical and Translational Science Institute, Winston-Salem, NC.

出版信息

J Pediatr Orthop. 2022;42(5):e544-e549. doi: 10.1097/BPO.0000000000002108.

DOI:10.1097/BPO.0000000000002108

PMID:35220337

Abstract

BACKGROUND

Postoperative urinary retention (POUR) is a surgical complication more prevalent in children with neurodisability and associated with an increase length of hospitalization. Risk factors include pre-existing bladder dysfunction, type and duration of surgery, anesthesia medications, postoperative opioid pain management, and patient demographics. The purpose of this investigation was (1) to determine the frequency of POUR following hip/lower limb orthopaedic procedures in which epidural analgesia was used for pain management; (2) to explore factors influencing postoperative bladder management.

METHODS

A retrospective analysis of clinical data was performed in an orthopaedic specialty care health care system. A health outcomes network was queried for patients with a diagnoses of cerebral palsy (ICD-9/10 codes) who had one of 57 unique CPT procedure codes corresponding to hip osteotomies or tenotomies from 2011 to 2019. All surgical observations included in analysis required a discrete data element and the confirmation of a secondary proxy. The database was also queried for postoperative medications received and patient demographics of interest.

RESULTS

A total of 704 surgical procedures met inclusion criteria resulting in a patient population with a mean age of 11 years, 58% male, 53% Caucasian, and 55% classified as quadriplegia [51% Gross Motor Function Classification System (GMFCS) levels IV/V]. Three hundred and thirty-five procedures (48%) involved epidural anesthesia. Sixty-five patients required intermittent catheterization (9.2%) postoperatively following foley catheter removal, of which 23 (3.3%) required recatheterization. The rate of recatheterization was similar regardless of anesthesia mode; 1.8% for general and 1.4% for epidural and was associated with a greater number of pain medications. Epidural anesthesia resulted in significantly longer periods of catheterization. For the total group the time to urinary catheter removal differed significantly among cerebral palsy subtypes, GMFCS Level, race, and ethnicity. Factors identified as significant predictors of the length of catheterization were epidural analgesia, number of pain medications, and osteotomy.

CONCLUSIONS

The number of postoperative pain medications utilized was more predictive of POUR than the mode of analgesia delivery; however, epidural analgesia and the type of surgical procedure did significantly impact the length of catheterization.

LEVEL OF EVIDENCE

Level III.

摘要

背景

术后尿潴留（POUR）是一种更常见于神经功能障碍儿童的手术并发症，与住院时间延长有关。危险因素包括预先存在的膀胱功能障碍、手术类型和持续时间、麻醉药物、术后阿片类药物疼痛管理以及患者人口统计学特征。本研究的目的是：（1）确定使用硬膜外镇痛进行疼痛管理的髋关节/下肢矫形手术后 POUR 的频率；（2）探讨影响术后膀胱管理的因素。

方法

对矫形专科医疗保健系统中的临床数据进行回顾性分析。对一个健康结果网络进行了查询，该网络中包含了 2011 年至 2019 年期间诊断为脑瘫（ICD-9/10 代码）的患者，他们接受了 57 种独特的 CPT 手术代码之一，这些代码对应髋关节切开术或肌腱切开术。分析中包含的所有手术观察均需要离散数据元素和次要代理的确认。还对术后用药和感兴趣的患者人口统计学特征进行了数据库查询。

结果

共有 704 例手术符合纳入标准，患者平均年龄为 11 岁，男性占 58%，白种人占 53%，55%为四肢瘫[51%的总体运动功能分类系统（GMFCS）水平 IV/V]。335 例（48%）手术采用硬膜外麻醉。 Foley 导管拔除后，65 名患者（9.2%）需要间歇性导尿，其中 23 名（3.3%）需要再次导尿。无论麻醉模式如何，再导尿的发生率相似；全身麻醉为 1.8%，硬膜外麻醉为 1.4%，且与更多的疼痛药物有关。硬膜外麻醉导致导尿管留置时间明显延长。对于总组，脑瘫亚型、GMFCS 水平、种族和民族之间的尿导管移除时间有显著差异。确定为导管插入术长度的显著预测因素的因素是硬膜外镇痛、疼痛药物的数量和截骨术。