婴儿先天性畸形修复术微创与开放手术的围手术期结局。
Perioperative outcomes in minimally-invasive versus open surgery in infants undergoing repair of congenital anomalies.
机构信息
Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA.
Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Division of Global Women's Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA.
出版信息
J Pediatr Surg. 2022 Dec;57(12):755-762. doi: 10.1016/j.jpedsurg.2022.08.002. Epub 2022 Aug 10.
BACKGROUND
This study compared perioperative outcomes among infants undergoing repair of congenital anomalies using minimally invasive (MIS) versus open surgical approaches.
METHODS
The ACS NSQIP Pediatric (2013-2018) was queried for patients undergoing repair of any of the following 9 congenital anomalies: congenital lung lesion (LL), mediastinal mass (MM), congenital malrotation (CM), anorectal malformation (ARM), Hirschsprung disease (HD), congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), hepatobiliary anomalies (HB), and intestinal atresia (IA). Inverse probability of treatment weights (IPTW) derived from propensity scores were utilized to estimate risk-adjusted association between surgical approach and 30-day outcomes.
RESULTS
12,871 patients undergoing congenital anomaly repair were included (10,343 open; 2528 MIS). After IPTW, MIS was associated with longer operative time (difference; 95% CI) (16 min; 9-23) and anesthesia time (13 min; 6-21), but less postoperative ventilation days (-1.0 days; -1.4- -0.6) and shorter postoperative length of stay (-1.4 days; -2.4- -0.3). MIS repairs had decreased risk of any surgical complication (risk difference: -6.6%; -9.2- -4.0), including hematologic complications (-7.3%; -8.9- -5.8). There was no significant difference in risk of complication when hematologic complications were excluded (RD -2.3% [-4.7%, 0.1%]). There were no significant differences in the risk of unplanned reoperation (0.4%; -1.5-2.2) or unplanned readmission (0.2%; -1.2-1.5).
CONCLUSIONS
MIS repair of congenital anomalies is associated with improved perioperative outcomes when compared to open. Additional studies are needed to compare long-term functional and disease-specific outcomes.
MINI-ABSTRACT: In this propensity-weighted multi-institutional analysis of nine congenital anomalies, minimally invasive surgical repair was associated with improved 30-day outcomes when compared to open surgical repair.
LEVEL OF EVIDENCE
III.
背景
本研究比较了婴儿接受微创（MIS）与开放手术治疗先天性畸形的围手术期结果。
方法
通过美国外科医师学会国家外科质量改进计划儿科数据库（2013-2018 年），检索了 9 种先天性畸形（肺脏病变、纵隔肿块、先天性旋转不良、肛门直肠畸形、先天性巨结肠、先天性膈疝、气管食管瘘、肝胆异常和肠闭锁）患者接受修复手术的病例。采用倾向评分的逆概率治疗加权（IPTW）估计手术方式与 30 天结果之间的风险调整关联。
结果
共纳入 12871 例先天性畸形修复患者（10343 例开放手术，2528 例微创）。经 IPTW 校正后，MIS 组手术时间（差值，95%CI）较长（16 分钟；9-23），麻醉时间较长（13 分钟；6-21），但术后通气时间较短（-1.0 天；-1.4 至-0.6），术后住院时间较短（-1.4 天；-2.4 至-0.3）。MIS 修复术的总体手术并发症风险降低（风险差：-6.6%；-9.2 至-4.0），包括血液学并发症（-7.3%；-8.9 至-5.8）。排除血液学并发症后，并发症风险差异无统计学意义（RD-2.3%[-4.7%，0.1%]）。未计划再次手术（0.4%；-1.5 至 2.2）和再入院（0.2%；-1.2 至 1.5）的风险无显著差异。
结论
与开放手术相比，微创治疗先天性畸形可改善围手术期结果。需要进一步的研究来比较长期的功能和疾病特异性结果。
简译
在这项针对九种先天性畸形的倾向评分加权多机构分析中，与开放手术修复相比，微创外科修复与改善 30 天结果相关。
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