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Abstract：
BACKGROUND: The remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient\'s hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA).
METHODS: We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event.
RESULTS: A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group.
CONCLUSIONS: We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.
METHODS: We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event.
RESULTS: A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group.
CONCLUSIONS: We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.
摘要：
背景：近年来外科技术的显著进步已经将临床重点从仅仅降低死亡率转移到提高术后恢复质量。患者的住院时间是评估术后恢复和手术结果的重要指标。这项研究旨在确定接受Ebstein异常（EA）矫正手术的儿童住院时间的预测因素。
方法：我们对2009年1月至2021年11月在阜外医院接受矫正手术的儿童（18岁以下）进行了回顾性队列研究。主要结果是出院时间（THD）。Cox比例风险模型用于确定THD的预测因子。在时间到事件分析的背景下，出院被认为是一个事件.如果死亡发生在出院前，它被定义为扩展的THD，输入为100天(超过观察到的最长THD)，并被视为非事件。
结果：本研究共纳入270名儿童，其中三人在医院死亡。在Cox比例风险分析之后，确定了THD的六个预测因子。风险比和相应的95%置信区间如下：年龄，1.030（1.005,1.055）；C/R>0.65，0.507（0.364,0.707）；CarpentierC型或D型，0.578（0.429,0.779）；CPB时间，0.995（0.991,0.998）；地塞米松，1.373（1.051,1.795）；输血，0.680（0.529,0.875）。根据THD的四分位数将儿童分为三组。与≤6天组的儿童相比，≥11日组的不良结局发生率较高.此外,机械通气的持续时间和ICU住院时间，以及医院费用，明显高于该组。
结论：我们确定了接受EA矫正手术的儿童THD的6个预测因子。临床医生可以利用这些变量来优化围手术期管理策略，减少不良并发症，改善术后恢复，减少不必要的医疗费用。
方法：我们对2009年1月至2021年11月在阜外医院接受矫正手术的儿童（18岁以下）进行了回顾性队列研究。主要结果是出院时间（THD）。Cox比例风险模型用于确定THD的预测因子。在时间到事件分析的背景下，出院被认为是一个事件.如果死亡发生在出院前，它被定义为扩展的THD，输入为100天(超过观察到的最长THD)，并被视为非事件。
结果：本研究共纳入270名儿童，其中三人在医院死亡。在Cox比例风险分析之后，确定了THD的六个预测因子。风险比和相应的95%置信区间如下：年龄，1.030（1.005,1.055）；C/R>0.65，0.507（0.364,0.707）；CarpentierC型或D型，0.578（0.429,0.779）；CPB时间，0.995（0.991,0.998）；地塞米松，1.373（1.051,1.795）；输血，0.680（0.529,0.875）。根据THD的四分位数将儿童分为三组。与≤6天组的儿童相比，≥11日组的不良结局发生率较高.此外,机械通气的持续时间和ICU住院时间，以及医院费用，明显高于该组。
结论：我们确定了接受EA矫正手术的儿童THD的6个预测因子。临床医生可以利用这些变量来优化围手术期管理策略，减少不良并发症，改善术后恢复，减少不必要的医疗费用。
