儿科创伤患者重返手术室的风险因素。
Risk Factors for Unplanned Returns to the Operating Room in Pediatric Trauma Patients.
机构信息
Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA, USA.
Department of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, USA.
出版信息
Am Surg. 2023 Oct;89(10):4072-4076. doi: 10.1177/00031348231175140. Epub 2023 May 20.
BACKGROUND
Unplanned returns to the operating room (uROR) are associated with worse outcomes including increased complications and length of stay (LOS) in adults. However, the incidence and predictors of uROR for pediatric trauma patients (PTPs) are unknown. This study aimed to identify predictors of uROR for PTPs.
METHODS
The 2017-2019 Trauma Quality Improvement Program database was queried for PTPs 1-16 years-old to compare patients with uROR to those without uROR. Multivariable logistic regression analysis was performed.
RESULTS
From 44 711 PTPs identified, 299 (.7%) underwent uROR. Pediatric trauma patients requiring uROR were older (14 vs 8 years old, < .001), had a higher rate and associated risk of mortality (8.7% vs 1.4%, < .001) (OR 6.67, CI 4.43-10.05, < .001) as well as increased complications including surgical infection (16.4% vs .2%, < .001) and compartment syndrome (4.7% vs .1%, < .001). Patients undergoing uROR had increased LOS (18 vs 2 days, < .001) and intensive care unit LOS (9 vs 3 days, < .001). Independent associated risk factors for uROR included rectal injury (OR 4.54, CI 2.28-9.04, < .001), brain injury (OR 3.68, CI 2.71-5.00, < .001), and gunshot wounds (OR 2.55, CI 1.83-3.56, < .001).
DISCUSSION
The incidence of uROR was <1% for PTPs. However, patients requiring uROR had increased LOS and associated risk of death compared to those without uROR. Predictors of uROR included gunshot wounds and injuries to the rectum and brain. Patients with these risk factors should be counseled with efforts made to improve care for these high-risk populations.
背景
非计划性手术室返回（uROR）与更差的结果相关，包括成人并发症增加和住院时间（LOS）延长。然而，儿科创伤患者（PTP）uROR 的发生率和预测因素尚不清楚。本研究旨在确定 PTPs uROR 的预测因素。
方法
对 2017-2019 年创伤质量改进计划数据库中 1-16 岁的 PTP 进行查询，比较 uROR 患者与无 uROR 患者。进行多变量逻辑回归分析。
结果
在确定的 44711 例 PTP 中，有 299 例（0.7%）接受 uROR。需要 uROR 的儿科创伤患者年龄较大（14 岁比 8 岁，<0.001），死亡率较高且存在相关风险（8.7%比 1.4%，<0.001）（OR 6.67，CI 4.43-10.05，<0.001），并发症包括手术感染（16.4%比 2%，<0.001）和筋膜室综合征（4.7%比 1%，<0.001）。接受 uROR 的患者 LOS 延长（18 天比 2 天，<0.001）和 ICU LOS 延长（9 天比 3 天，<0.001）。uROR 的独立相关危险因素包括直肠损伤（OR 4.54，CI 2.28-9.04，<0.001）、脑损伤（OR 3.68，CI 2.71-5.00，<0.001）和枪伤（OR 2.55，CI 1.83-3.56，<0.001）。
讨论
PTPs 的 uROR 发生率<1%。然而，与无 uROR 患者相比，需要 uROR 的患者 LOS 延长，死亡风险增加。uROR 的预测因素包括枪伤和直肠及脑损伤。有这些危险因素的患者应接受咨询，并努力改善这些高危人群的护理。
Zotero 插件