From the Division of Pediatric Surgery, University of British Columbia, Vancouver, BC (Butterworth); BC Children's Hospital, Vancouver, BC (Butterworth); the Faculty of Medicine, University of British Columbia, Vancouver, BC (Zivkovic); the Department of Urology, Dalhousie University, Halifax, NS; and the Department of Urology, University of British Columbia, BC Children's Hospital, Vancouver, BC (Afshar)
From the Division of Pediatric Surgery, University of British Columbia, Vancouver, BC (Butterworth); BC Children's Hospital, Vancouver, BC (Butterworth); the Faculty of Medicine, University of British Columbia, Vancouver, BC (Zivkovic); the Department of Urology, Dalhousie University, Halifax, NS; and the Department of Urology, University of British Columbia, BC Children's Hospital, Vancouver, BC (Afshar).
Can J Surg. 2023 Mar 17;66(2):E123-E131. doi: 10.1503/cjs.015421. Print 2023 Mar-Apr.
Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population.
We performed a retrospective review of class 1 (≤ 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children's Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the χ test for univariate analysis and logistic regression for multivariate analysis.
There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d-18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the high-risk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confidence interval 1.20-2.94) compared to no delay.
Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences.
急诊手术的延迟会导致发病率和死亡率的增加，而生理状况会影响需要紧急手术的患者的结局。我们的目的是在风险调整人群中确定儿童急诊手术的延迟是否与重大发病率或死亡率的增加相关。
我们对 2011 年 7 月 11 日至 2016 年 7 月 30 日期间在温哥华 BC 儿童医院进行的 1 类（≤60 分钟至手术室）手术进行了回顾性研究。数据来源包括手术室数据库、患者病历、美国麻醉医师协会分类、新生儿急性生理学评分（SNAP II）和儿科死亡率风险评分（PRISM III）、从预约到手术室的时间和结果。患者分为低死亡风险和高死亡风险。我们将主要发病率定义为与手术相关的器官、肢体或功能的意外丧失，并将手术延迟定义为从预约到进入手术室超过 60 分钟。我们使用 χ2 检验进行单变量分析，使用逻辑回归进行多变量分析。
共有 384 例（367 名患者），其中 223 例为高风险，161 例为低风险。中位年龄为 4 岁（范围 0 天-18 岁）。总体而言，184 例（47.9%）被延迟。发生重大发病率的有 94 例（24.5%），28 例（7.6%）（均为高风险组）死亡。有重大发病率/死亡率的患者到达手术室的平均时间为 1.46 小时，无重大发病率/死亡率的患者为 1.17 小时。在调整风险水平后，多变量分析显示手术延迟与发病率和/或死亡率增加 85%相关（调整后的优势比为 1.85，95%置信区间为 1.20-2.94），与无延迟相比。
急诊手术的延迟与重大发病率和/或死亡率的显著增加相关。需要紧急手术的儿童不仅需要手术室团队，还需要医院和政府优先考虑他们的护理；否则，他们将继续遭受意外后果。
