背景:先前的研究表明,21三体(T21)患者的先天性巨结肠(HD)手术结果较差。使用大型国家数据库,我们试图调查T21型HD患者与非T21型HD患者的手术结局.
方法:我们从2012年到2021年利用了去识别的国家外科质量改善计划儿科数据库。使用国际疾病分类,第九次修订代码,纳入年龄<18岁的HD儿童,并通过T21诊断进行分层。人口统计,当前程序术语代码,案例特征,住院时间,并对术后并发症进行分析。
结果:在3456例HD患者中,12.0%(n=413)的患者同时诊断为T21。牵拉(PT)手术占手术的54.9%(n=1896),其中10.0%(n=189)患有T21。接受PT的T21患者的胎龄较小(P<0.0001),心脏危险因素(P<0.0001),血液病(P<0.0001),高等美国麻醉医师学会班(P<0.0001),并且在他们的索引操作中年龄较大(P=0.03)。尽管手术时间相似,T21患者总住院时间较长(P=0.0263),术后住院时间(P=0.0033),以及更多的计划外再操作(P=0.0094)。尽管仅在未经调整的分析中具有重要意义,T21患者术后并发症较多(P=0.0034),特别是深部手术部位感染(P=0.009),器官/空间手术部位感染(P=0.004),伤口破裂(P<0.001),脓毒症(P=0.025)。
结论:我们确认T21和非T21患者之间存在显著差异,特别是增加了总停留时间,术后住院时间,和计划外的再操作。了解这些差异将为这个独特的患者群体带来更优化的治疗计划。
BACKGROUND: Previous studies have demonstrated worse outcomes for Hirschsprung\'s disease (HD) procedures in Trisomy 21 (T21) patients. Using a large national database, we sought to investigate surgical outcomes in HD patients with T21 compared to non-T21 patients.
METHODS: We utilized the deidentified National Surgical Quality Improvement Program Pediatric database from 2012 to 2021. Using International Classification of Diseases, Ninth Revision codes, children <18 y old with HD were included and stratified by T21 diagnosis. Demographics, Current Procedural Terminology codes, case characteristics, length of hospital stay, and postoperative complications were analyzed.
RESULTS: Of 3456 HD patients, 12.0% (n = 413) patients had a concurrent diagnosis of T21. Pull-through (PT) procedures accounted for 54.9% of surgeries (n = 1896), of which 10.0% (n = 189) had T21. T21 patients who underwent PT had a younger gestational age (P < 0.0001), cardiac risk factors (P < 0.0001), hematologic disorders (P < 0.0001), higher American Society of Anesthesiologists class (P < 0.0001), and were older at their index operation (P = 0.03). Though operative times were similar, T21 patients had a longer total length of stay (P = 0.0263), postoperative length of stay (P = 0.0033), and more unplanned reoperations (P = 0.0094). Though only significant in unadjusted analyses, T21 patients had more postoperative complications after PT (P = 0.0034), specifically deep surgical site infections (P = 0.009), organ/space surgical site infections (P = 0.004), wound disruption (P < 0.001), and sepsis (P = 0.025).
CONCLUSIONS: We confirm significant differences exist between T21 and non-T21 patients undergoing HD procedures, particularly increased total length of stay, postoperative length of stay, and unplanned reoperations. Understanding these differences will lead to more optimal treatment plans for this unique patient population.