A Comparison Study of Major and Minor Complications After Inpatient Versus Outpatient Pediatric Brachial Plexus Surgery: A Preliminary Report.

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-09-01 Epub Date: 2025-07-21 DOI:10.1097/BPO.0000000000002979
Kirby W Bonvillain, Eliana B Saltzman, Julia C Mastracci, Katherine D Drexelius, Andrew C Herman, Kennedy K Gachigi, Bryan J Loeffler, Peter M Waters, Raymond Glenn Gaston
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引用次数: 0

Abstract

Background: Interest in outpatient surgery has grown secondary to emphasis on the delivery of efficient, high-quality care. This study sought to compare 90-day complications between pediatric patients undergoing outpatient versus inpatient brachial plexus nerve surgery.

Methods: A single institution database was queried for primary exploration and treatment of brachial plexus birth injuries from 2011 to 2022. Standard demographic data and the American Society of Anesthesiologists (ASA) classification were recorded. Operative procedures included neurolysis, nerve transfers, and/or nerve grafting. Outcome measures included operative time, postoperative emergency department (ED) visits, unplanned readmissions, and reoperation within 90 days.

Results: The query yielded 19 patients. The mean age in the outpatient cohort was 7.1 months, and 5.9 months in the inpatient cohort. All patients were ASA I or II. The nerve injury levels, based on physical examination and intraoperative findings, revealed more global injuries in the inpatient group ( P = 0.182). There was a significant difference ( P = 0.001) in procedure length, with an average of 174.9 minutes for the outpatient cohort compared with 279.3 minutes for the inpatient cohort. This represents more extensive reconstructive surgery with concomitant nerve transfers and nerve grafting required for the inpatient group. There were zero unplanned readmissions or reoperations. When comparing surgeries performed from 2011 to 2016 to those performed from 2017 to 2022, inpatient admission odds decreased by 92% (OR: 0.08, P = 0.045). Those who represented the ED had 3 times the odds of inpatient care compared with those with no ED representation (OR: 3.43, P = 0.33). There were 3 ED visits in the inpatient cohort. Two patients presented due to minor parental incisional concerns that required no further management. The ED visit in the outpatient cohort was due to an unrelated fever.

Conclusions: Over time, criteria were established to guide decision-making as more surgeries were safely conducted outpatient with no difference in complications. In appropriately selected patients, such as those of ASA I and II status, outpatient brachial plexus surgery may be safe and considered value-based care.

Level of evidence: Level III-retrospective cohort, nerve transfer, muscle transfer.

住院与门诊儿童臂丛手术后主要和次要并发症的比较研究:初步报告。
背景:对门诊手术的兴趣已经发展到强调提供高效、高质量的护理。本研究旨在比较接受门诊和住院臂丛神经手术的儿童患者90天的并发症。方法:对2011 - 2022年臂丛出生损伤病例进行初步探查和治疗。记录标准人口统计数据和美国麻醉医师协会(ASA)分类。手术包括神经松解术、神经转移和/或神经移植。结果指标包括手术时间、术后急诊科(ED)就诊次数、计划外再入院和90天内再次手术。结果:查询得到19例患者。门诊队列的平均年龄为7.1个月,住院队列的平均年龄为5.9个月。所有患者均为ASA I或II级。基于体格检查和术中发现的神经损伤水平显示住院组有更多的全面性损伤(P = 0.182)。在手术时间上存在显著差异(P = 0.001),门诊队列的平均时间为174.9分钟,而住院队列的平均时间为279.3分钟。这表明住院患者需要更广泛的重建手术,同时需要神经移植和神经移植。没有计划外的再入院或再手术。将2011 - 2016年的手术与2017 - 2022年的手术进行比较,住院率降低了92% (OR: 0.08, P = 0.045)。那些代表急诊科的人住院治疗的几率是没有代表急诊科的人的3倍(OR: 3.43, P = 0.33)。住院队列中有3次急诊科就诊。两名患者因轻微的父母切口问题而就诊,无需进一步治疗。门诊队列的急诊科就诊是由于不相关的发烧。结论:随着时间的推移,建立了指导决策的标准,因为更多的手术在门诊安全进行,并发症没有差异。在适当选择的患者中,例如ASA I和II级的患者,门诊臂丛手术可能是安全的,并且被认为是基于价值的护理。证据等级:iii级-回顾性队列,神经转移,肌肉转移。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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