漏斗胸修复术后的结果：中心容积很重要。

Outcomes After Pectus Excavatum Repair: Center Volume Matters.

机构信息

DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA.

出版信息

J Pediatr Surg. 2024 May;59(5):935-940. doi: 10.1016/j.jpedsurg.2024.01.020. Epub 2024 Jan 29.

DOI:10.1016/j.jpedsurg.2024.01.020

PMID:38360451

Abstract

PURPOSE

Pectus excavatum (Pectus) repair may be offered for those with significant cardiopulmonary compromise or severe cosmetic defects. The influence of hospital center volume on postoperative outcomes in children is unknown. This study aimed to investigate the outcomes of children undergoing Pectus repair, stratified by hospital surgical volume.

METHODS

The Nationwide Readmission Database was queried (2016-2020) for patients with Pectus (Q67.6). Patients were stratified into those who received repair at high-volume centers (HVCs; ≥20 repairs annually) versus low-volume centers (LVCs; <20 repairs annually). Demographics and outcomes were analyzed using standard statistical tests.

RESULTS

A total of 9414 patients with Pectus underwent repair during the study period, with 69% treated at HVCs and 31% at LVCs. Patients at LVCs experienced higher rates of complications during index admission, including pneumothorax (23% vs. 15%), chest tube placement (5% vs. 2%), and overall perioperative complications (28% vs. 24%) compared to those treated at HVCs, all p < 0.001. Patients treated at LVCs had higher readmission rates within 30 days (3.8% vs. 2.8% HVCs) and overall readmission (6.8% vs. 4.7% HVCs), both p < 0.010. Among readmitted patients (n = 547), the most frequent complications during readmission for those initially treated at LVCs included pneumothorax/hemothorax (21% vs. 8%), bar dislodgment (21% vs. 12%), and electrolyte disorders (15% vs. 9%) compared to those treated at HVCs.

CONCLUSION

Pediatric Pectus repair performed at high-volume centers was associated with fewer index complications and readmissions compared to lower-volume centers. Patients and surgeons should consider this hospital volume-outcome relationship.

TYPE OF STUDY

Retrospective Comparative.

LEVEL OF EVIDENCE

III.

摘要

目的

对于心肺功能严重受损或严重美容缺陷的患者，可考虑进行漏斗胸（pectus）修复术。目前尚不清楚医院中心手术量对儿童术后结果的影响。本研究旨在调查漏斗胸患儿接受修复术的结果，并按医院手术量进行分层。

方法

本研究通过国家再入院数据库（2016-2020 年）查询了患有漏斗胸（Q67.6）的患者。患者分为在高容量中心（HVC；每年修复≥20 例）和低容量中心（LVC；每年修复<20 例）接受修复的患者。使用标准统计检验分析人口统计学和结果。

结果

在研究期间，共有 9414 名患有漏斗胸的患者接受了修复术，其中 69%在 HVC 治疗，31%在 LVC 治疗。与在 HVC 治疗的患者相比，在 LVC 治疗的患者在入院时出现并发症的比率更高，包括气胸（23% vs. 15%）、放置胸腔引流管（5% vs. 2%）和整体围手术期并发症（28% vs. 24%），所有差异均有统计学意义（均 P < 0.001）。与在 HVC 治疗的患者相比，在 LVC 治疗的患者在 30 天内的再入院率（3.8% vs. 2.8% HVCs）和总体再入院率（6.8% vs. 4.7% HVCs）均较高，均有统计学意义（均 P < 0.010）。在接受再入院治疗的患者中（n=547），与在 HVC 治疗的患者相比，最初在 LVC 治疗的患者再入院时最常见的并发症包括气胸/血胸（21% vs. 8%）、矫正板移位（21% vs. 12%）和电解质紊乱（15% vs. 9%）。