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Abstract：
Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database. Methods The health care cost and utilization project Kids\' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients. Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day ( p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 ( p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing. Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.
摘要：
目的该研究的目的是使用国家儿科住院数据库评估术前血管栓塞（PVE）对青少年鼻咽血管纤维瘤（JNA）手术结果的影响。方法查询1997年至2016年JNA所有手术管理病例的医疗费用和利用项目儿童住院患者数据库。根据患者是否接受PVE对病例进行分层。在控制患者人口统计学因素和合并症的同时，使用多元线性回归预测PVE对住院时间（LOS）和总费用的影响。使用二元逻辑回归计算PVE患者接受围手术期输血的比值比（OR）。结果共有473例患者在此时间段内接受了JNA手术切除。PVE的使用率从1997年的0％增加到2016年的66％。发现PVE可将LOS降低1天（p=0.036），并降低需要围手术期输血的几率（OR=0.511，p=0.041）。接受PVE的患者被额外收取35,600美元(p<0.001)，但2016年的最新数据表明，PVE的医院成本正在下降。结论JNA的PVE越来越普遍。栓塞导致医院LOS降低和需要输血的几率降低。虽然栓塞增加了管理成本，这一趋势应该重新评估，因为这一程序正变得越来越普遍。
