Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.
Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.
J Surg Res. 2024 Aug;300:231-240. doi: 10.1016/j.jss.2024.05.001. Epub 2024 Jun 1.
Spina bifida (SB) occurs in 3.5/10,000 live births and is associated with significant long-term neurologic and urologic morbidity. We explored the characteristics and outcomes of pediatric patients with SB and the facilities that treat them in Texas.
We retrospectively reviewed a statewide hospital inpatient discharge database (2013-2021) to identify patients aged <18 y with SB using International Classification of Diseases 9/10 codes. Patients transferred to outside hospitals were excluded to avoid double-counting. Descriptive statistics and chi-square test were performed.
Seven thousand five hundred thirty one inpatient hospitalizations with SB were analyzed. Most SB care is provided by a few facilities. Two facilities (1%) averaged >100 SB admissions per year (33% of patients), while 15 facilities (8%) treat 10-100 patients per year (51% of patients). Most facilities (145/193, 75%) average less than one patient per year. Infants tended to be sicker (17% extreme illness severity, P < 0.001). Overall mortality is low (1%), primarily occurring in the neonatal period (8%, P < 0.001). Most admissions are associated with surgical intervention, with 63% of encounters having operating room charges with an average cost of $25,786 ± 24,884. Admissions for spinal procedures were more common among infants, whereas admissions for genitourinary procedures were more common among older patients (P < 0.001). The average length of stay was 8 ± 16 d with infants having the longest length of stay (19 ± 33, P < 0.001).
Patients have significant long-term health needs with evolving pediatric surgical indications as they grow. Pediatric SB care is primarily provided by a small number of facilities in Texas. Longitudinal care coordination of their multidisciplinary surgical care is needed to optimize patient care.
脊柱裂（SB）的发病率为每 10000 例活产儿中有 3.5 例，与严重的长期神经和泌尿系统发病率有关。我们探索了德克萨斯州患有 SB 的儿科患者的特征和结局，以及治疗这些患者的设施。
我们回顾性地审查了全州医院住院患者数据库（2013-2021 年），使用国际疾病分类第 9/10 版代码来识别年龄<18 岁的 SB 患者。排除转往其他医院的患者，以避免重复计数。进行了描述性统计和卡方检验。
共分析了 7531 例 SB 住院患者。大多数 SB 护理由少数几家医疗机构提供。两家医院（1%）平均每年收治 100 多名 SB 患者（占患者的 33%），而 15 家医院（8%）每年治疗 10-100 名患者（占患者的 51%）。大多数医疗机构（145/193，75%）平均每年不到一名患者。婴儿的病情往往更严重（17%的严重程度为极严重，P<0.001）。总体死亡率较低（1%），主要发生在新生儿期（8%，P<0.001）。大多数入院与手术干预有关，63%的入院有手术室费用，平均费用为 25786±24884 美元。婴儿更常见脊柱手术，而老年患者更常见泌尿生殖系统手术（P<0.001）。平均住院时间为 8±16 天，婴儿的住院时间最长（19±33，P<0.001）。
随着患者的成长，他们有显著的长期健康需求，并出现了不断发展的儿科手术指征。德克萨斯州的 SB 患儿主要由少数几家医疗机构提供治疗。需要对其多学科手术护理进行纵向护理协调，以优化患者护理。
