MacIsaac Molly F, Wright Joshua M, Le Nicole K, Phillips Lee G, Belzberg Allan J, Rottgers S Alex, Halsey Jordan N
Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, 601 Fifth Street South, Suite 611, St. Petersburg, FL, USA.
Department of Plastic Surgery, University of South Florida, Tampa, FL, USA.
Childs Nerv Syst. 2024 Dec 12;41(1):45. doi: 10.1007/s00381-024-06709-w.
This study aims to explore demographic disparities, regional and institutional variations, surgical timing, narcotic use, and management trends in neonatal brachial plexus palsy (NBPP) patients due to limited published literature.
We conducted a retrospective cohort study using the Pediatric Health Information System (PHIS) database of NBPP patients who underwent surgery within the first 2 years of life. Patients were stratified into two groups based on age at surgery: ≤ 8 months and > 8 months.
A total of 788 patients were identified, with a mean surgical age of 8.1 months. Black patients were disproportionately affected (29%), over twice their national birth rate (14%). Narcotic use was more common in younger patients (63% vs. 53%, p = 0.003), as well as in those treated in the West (71%, p = 0.001) and Northeast (73%, p = 0.004), and by plastic (74%, p < 0.0001) or orthopedic surgeons (69%, p = 0.002). Patients prescribed narcotics had longer hospital stays (1.7 vs. 1.2 days, p < 0.0001) and higher complication rates (7.9% vs. 3.1%, p = 0.009). Narcotic use decreased significantly over the study period (p = 0.002). Short-term outcomes, including complication and readmission rates, were similar across the three primary surgical specialties (plastic, orthopedic, and neurosurgery). High-volume centers had lower complication rates (1.5% vs. 5.4%, p = 0.002) and ICU admissions (5.8% vs. 18%, p < 0.0001) compared to medium-volume centers.
While narcotic use was associated with longer stays and complications, short-term outcomes were consistent across specialties. Standardized care protocols may help improve patient outcomes.
由于已发表的文献有限，本研究旨在探讨新生儿臂丛神经麻痹（NBPP）患者的人口统计学差异、地区和机构差异、手术时机、麻醉药物使用及管理趋势。
我们使用儿科健康信息系统（PHIS）数据库对在出生后2年内接受手术的NBPP患者进行了一项回顾性队列研究。根据手术时的年龄将患者分为两组：≤8个月和>8个月。
共识别出788例患者，平均手术年龄为8.1个月。黑人患者受影响的比例过高（29%），超过其全国出生率（14%）的两倍。麻醉药物的使用在较年轻的患者中更为常见（63%对53%，p = 0.003），在西部（71%，p = 0.001）和东北部（73%，p = 0.004）接受治疗的患者中也是如此，以及由整形外科医生（74%，p < 0.0001）或骨科医生（69%，p = 0.002）治疗的患者。使用麻醉药物的患者住院时间更长（1.7天对1.2天，p < 0.0001）且并发症发生率更高（7.9%对3.1%，p = 0.009）。在研究期间麻醉药物的使用显著减少（p = 0.002）。包括并发症和再入院率在内的短期结局在三个主要外科专科（整形外科、骨科和神经外科）中相似。与中等规模的中心相比，高容量中心的并发症发生率较低（1.5%对5.4%，p = 0.002）且入住重症监护病房的比例较低（5.8%对18%，p < 0.0001）。
虽然麻醉药物的使用与更长的住院时间和并发症相关，但各专科的短期结局是一致的。标准化的护理方案可能有助于改善患者结局。
