Jardaly Achraf, Torrez Timothy W, McGwin Gerald, Gilbert Shawn R
Department of Orthopaedics, Hughston Foundation/Hughston Clinic, Columbus, GA 31909, United States.
Department of Orthopedics, University of Alabama, Birmingham, AL 35205, United States.
World J Orthop. 2022 Apr 18;13(4):373-380. doi: 10.5312/wjo.v13.i4.373.
Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting. Two recent examples include slipped capital femoral epiphysis (SCFE) and Blount's disease. Surgical indications are well-studied for each pathology, but to our knowledge, there is an absence in literature analyzing safety and efficacy of inpatient outpatient management of either condition. We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.
To investigate whether outpatient surgery for SCFE and Blount's disease is associated with increased risk of adverse outcomes.
The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics, rates of complications, and readmissions between outpatient and inpatient surgery for SCFE and Blount's disease.
Total 1788 SCFE database entries were included, 30% were performed in an outpatient setting. pinning was used in 98.5% of outpatient surgeries and 87.8% of inpatient surgeries ( < 0.0001). Inpatients had a greater percent of total complications than outpatients 2.57% and 1.65% respectively. Regarding Blount's disease, outpatient surgeries constituted 41.2% of the 189 procedures included in our study. The majority of inpatients were treated with a tibial osteotomy, while the majority of outpatients had a physeal arrest ( < 0.0001). Complications were encountered in 7.4% of patients, with superficial surgical site infections and wound dehiscence being the most common. 1.6% of patients had a readmission. No differences in complication and readmission risks were found between inpatients and outpatients.
The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting. This can be safely performed for a large portion of children with SCFE and Blount's disease without increasing the risk of complications or readmissions. Osteotomies are more commonly performed in an inpatient setting where monitoring is available.
小儿骨科目前的趋势是门诊手术成功完成的数量有所增加。最近的两个例子包括股骨头骨骺滑脱（SCFE）和布朗特病。每种病理的手术指征都有充分研究，但据我们所知，尚无文献分析这两种病症住院与门诊治疗的安全性和有效性。我们认为这两种病症的门诊治疗不会增加不良后果。
调查SCFE和布朗特病的门诊手术是否会增加不良后果的风险。
使用2015 - 2017年美国外科医师学会国家外科质量改进计划儿科登记处的数据，比较SCFE和布朗特病门诊手术与住院手术的患者特征、并发症发生率和再入院率。
共纳入1788条SCFE数据库记录，其中30%为门诊手术。98.5%的门诊手术和87.8%的住院手术采用了钢针固定（P < 0.0001）。住院患者的总并发症发生率高于门诊患者，分别为2.57%和1.65%。关于布朗特病，门诊手术占我们研究中189例手术的41.2%。大多数住院患者接受胫骨截骨术治疗，而大多数门诊患者进行骨骺阻滞（P < 0.0001）。7.4%的患者出现并发症，最常见的是浅表手术部位感染和伤口裂开。1.6%的患者再次入院。住院患者和门诊患者在并发症和再入院风险方面没有差异。
目前的趋势是倾向于更早出院并在门诊进行手术。对于大部分患有SCFE和布朗特病的儿童，这样做可以安全进行，而不会增加并发症或再入院的风险。截骨术更常在可进行监测的住院环境中进行。
