Striano Brendan M, Talwar Divya, Flynn John M, Williams Brendan A, Mitchell Stuart L, Shah Apurva S
Harvard Combined Orthopaedic Residency Program, Boston, MA.
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Soc North Am. 2024 Feb 12;5(1):422. doi: 10.55275/JPOSNA-2023-422. eCollection 2023 Feb.
Open reduction and percutaneous pinning (ORPP) of pediatric supracondylar humerus (SCH) fractures is associated with increased morbidity compared to closed reduction. This investigation sought to assess variation in ORPP rates among U.S. children's hospitals by hospital treatment volume and ranking. Secondarily, we investigated costs associated with ORPP and closed reduction and percutaneous pinning (CRPP). The Pediatric Health Information System (PHIS), a database of U.S. children's hospitals, was queried for patients 3-10 years treated with ORPP or CRPP for closed SCH fractures from 2010-2014. Pediatric orthopaedic hospital rankings were collected from . To account for differences in patient population, hospital ORPP rates were adjusted for patient characteristics. Analysis then assayed the effect of hospital treatment and ranking on cost of care and likelihood to treat with ORPP. 28,100 patients were treated at 42 pediatric hospitals. 26,465 (94.2%) SCH fractures underwent CRPP and 1,635 (5.8%) underwent ORPP. Unadjusted ORPP rates varied from 1.9%-12.8%. Adjusted for patient characteristics, ORPP rates ranged from 4.2%-15.0%. Analysis demonstrated significant variation in cost and ORPP rates between hospitals (p<0.001). Patients treated at high-volume centers were less likely to undergo ORPP than patients at lower-volume centers (5.1% vs. 6.7%; Odds Ratio 0.70, 95% CI: 0.54-0.90). There was no difference in ORPP rates based on the ranking. Cost of care was also significantly lower at high-volume centers (p<0.001). At hospitals with low surgical volumes, children with SCH fractures are more likely to undergo ORPP and have a significantly higher cost of care. Therapeutic Level III •There is variability in operative pediatric supracondylar humerus (SCH) fracture care with some patients receiving less invasive closed reduction and percutaneous pinning (CRPP) and some receiving more morbid open reduction and percutaneous pinning (ORPP).•Patients treated at high-volume hospitals are 30% less likely to receive ORPP compared to patients treated at low-volume centers.•Cost of care was significantly less expensive at high-volume hospitals.
与闭合复位相比，小儿肱骨髁上骨折（SCH）的切开复位及经皮穿针固定术（ORPP）会增加发病率。本研究旨在评估美国儿童医院中ORPP率随医院治疗量及排名的变化情况。其次，我们调查了ORPP以及闭合复位及经皮穿针固定术（CRPP）的相关费用。查询了美国儿童医院数据库儿科健康信息系统（PHIS）中2010 - 2014年接受ORPP或CRPP治疗闭合性SCH骨折的3 - 10岁患者。收集了儿科骨科医院排名。为了考虑患者群体差异，对医院的ORPP率按患者特征进行了调整。然后分析评估了医院治疗及排名对护理成本和采用ORPP治疗可能性的影响。42家儿科医院共治疗了28100例患者。26465例（94.2%）SCH骨折接受了CRPP，1635例（5.8%）接受了ORPP。未经调整的ORPP率在1.9% - 12.8%之间。按患者特征调整后，ORPP率在4.2% - 15.0%之间。分析表明各医院之间在成本和ORPP率上存在显著差异（p<0.001）。与治疗量较低的中心相比，在治疗量较高的中心接受治疗的患者接受ORPP的可能性更小（5.1%对6.7%；优势比0.70，95%置信区间：[0.54, 0.90]）。基于排名的ORPP率没有差异。治疗量较高的中心的护理成本也显著更低（p<0.001）。在手术量较低的医院，患有SCH骨折的儿童更有可能接受ORPP，且护理成本显著更高。治疗水平III •小儿肱骨髁上骨折（SCH）的手术治疗存在差异，一些患者接受侵入性较小的闭合复位及经皮穿针固定术（CRPP），一些患者接受创伤更大的切开复位及经皮穿针固定术（ORPP）。•与在治疗量较低的中心接受治疗的患者相比，在治疗量较高的医院接受治疗的患者接受ORPP的可能性低30%。•治疗量较高的医院的护理成本显著更低。
