减少单纯性胃裂住院时间：国家外科质量改进计划（NSQIP）的分析

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-26 DOI:10.1016/j.jpedsurg.2025.162262

Erwin T. Cabacungan , Amy J. Wagner , Ruby Gupta

{"title":"减少单纯性胃裂住院时间：国家外科质量改进计划（NSQIP）的分析","authors":"Erwin T. Cabacungan , Amy J. Wagner , Ruby Gupta","doi":"10.1016/j.jpedsurg.2025.162262","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Gastroschisis (GS) is the most common abdominal defect in infants, yet lack of consensus has led to variations in its management and outcomes. Length of stay (LOS) is an important measure of surgical quality and efficiency in GS infants. LOS depends on clinical and patient-related factors such as simple (sGS) or complex (cGS), type of surgery, associated complications, and factors such as the use of standardized care protocols.</div></div><div><h3>Objectives</h3><div>To determine the annual trends in LOS for sGS and identify the predictors leading to these trends.</div></div><div><h3>Methods/design</h3><div>We conducted a retrospective cohort study of infants with sGS using the 2012–2022 NSQIP-Pediatrics dataset. Predictor variable for LOS was the year of admission divided into five groups. Demographics, preoperative risk factors, and postoperative complications and outcomes were collected.</div></div><div><h3>Results</h3><div>From 2012 to 2022, median LOS decreased by five days (30–25 days, p-value= <0.001). We also found that there was a decrease sGS cases in NSQIP dataset (0.34/100 to 0.16/100 infants, p-value= <0.001) was noted. There was an increasing percentage of sGS for Hispanic race, inborn, higher birthweight, and superficial incisional surgical site infection (sSSI), a trend towards increasing gestational age, but no differences in timing of surgery and unplanned readmission. Stratified Cox proportional model analysis revealed that gestational age of <36 weeks, bleeding/transfusions [Hazard Ratio (HR) = 0.53, p < 0.001] and nutritional support at discharge (HR = 0.27, p < 0.001) were associated with significantly longer LOS.</div></div><div><h3>Conclusion</h3><div>The trends in LOS reduction in sGS infants point towards higher birth weight, later gestational age and more optimal management. It underscores the importance of utilizing national registry databases to better understand the outcomes. Despite these improvements, the observed variations in demographics and outcomes indicate a need for standardized care protocols and a better understanding of the factors influencing LOS.</div></div><div><h3>Level of Evidence</h3><div>Level II.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162262"},"PeriodicalIF":2.4000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Decreasing Length of Stay for Simple Gastroschisis: Analysis of the National Surgical Quality Improvement Program (NSQIP)\",\"authors\":\"Erwin T. Cabacungan , Amy J. Wagner , Ruby Gupta\",\"doi\":\"10.1016/j.jpedsurg.2025.162262\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Gastroschisis (GS) is the most common abdominal defect in infants, yet lack of consensus has led to variations in its management and outcomes. Length of stay (LOS) is an important measure of surgical quality and efficiency in GS infants. LOS depends on clinical and patient-related factors such as simple (sGS) or complex (cGS), type of surgery, associated complications, and factors such as the use of standardized care protocols.</div></div><div><h3>Objectives</h3><div>To determine the annual trends in LOS for sGS and identify the predictors leading to these trends.</div></div><div><h3>Methods/design</h3><div>We conducted a retrospective cohort study of infants with sGS using the 2012–2022 NSQIP-Pediatrics dataset. Predictor variable for LOS was the year of admission divided into five groups. Demographics, preoperative risk factors, and postoperative complications and outcomes were collected.</div></div><div><h3>Results</h3><div>From 2012 to 2022, median LOS decreased by five days (30–25 days, p-value= <0.001). We also found that there was a decrease sGS cases in NSQIP dataset (0.34/100 to 0.16/100 infants, p-value= <0.001) was noted. There was an increasing percentage of sGS for Hispanic race, inborn, higher birthweight, and superficial incisional surgical site infection (sSSI), a trend towards increasing gestational age, but no differences in timing of surgery and unplanned readmission. Stratified Cox proportional model analysis revealed that gestational age of <36 weeks, bleeding/transfusions [Hazard Ratio (HR) = 0.53, p < 0.001] and nutritional support at discharge (HR = 0.27, p < 0.001) were associated with significantly longer LOS.</div></div><div><h3>Conclusion</h3><div>The trends in LOS reduction in sGS infants point towards higher birth weight, later gestational age and more optimal management. It underscores the importance of utilizing national registry databases to better understand the outcomes. Despite these improvements, the observed variations in demographics and outcomes indicate a need for standardized care protocols and a better understanding of the factors influencing LOS.</div></div><div><h3>Level of Evidence</h3><div>Level II.</div></div>\",\"PeriodicalId\":16733,\"journal\":{\"name\":\"Journal of pediatric surgery\",\"volume\":\"60 5\",\"pages\":\"Article 162262\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-02-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of pediatric surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022346825001071\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pediatric surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022346825001071","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

摘要

背景：腹裂（GS）是婴儿最常见的腹部缺陷，但由于缺乏共识，导致其治疗和结果存在差异。住院时间（LOS）是衡量GS患儿手术质量和效率的重要指标。LOS取决于临床和患者相关因素，如简单（sGS）或复杂（cGS）、手术类型、相关并发症以及标准化护理方案的使用等因素。目的确定sGS年度LOS的趋势，并确定导致这些趋势的预测因素。方法/设计我们使用2012-2022年nsqip -儿科数据集对sGS婴儿进行回顾性队列研究。LOS的预测变量为入院年份，分为五组。收集人口统计学、术前危险因素、术后并发症和结果。结果从2012年到2022年，LOS中位数下降了5天（30-25天，p值= <0.001）。我们还发现NSQIP数据集中的sGS病例有所减少（0.34/100至0.16/100婴儿，p值= <0.001）。西班牙裔、出生、高出生体重和手术部位浅表切口感染（sSSI）的sGS百分比增加，有增加胎龄的趋势，但在手术时间和意外再入院方面没有差异。分层Cox比例模型分析显示，孕龄36周，出血/输血[HR] = 0.53, p <；0.001]和出院时的营养支持(HR = 0.27, p <；0.001)与较长的LOS相关。结论sGS患儿的LOS减少趋势是新生儿出生体重增加、胎龄增加和处理方法优化。它强调了利用国家登记数据库更好地了解结果的重要性。尽管有这些改进，但观察到的人口统计学和结果的差异表明需要标准化的护理方案和更好地了解影响LOS的因素。证据等级：II级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Decreasing Length of Stay for Simple Gastroschisis: Analysis of the National Surgical Quality Improvement Program (NSQIP)

Background

Gastroschisis (GS) is the most common abdominal defect in infants, yet lack of consensus has led to variations in its management and outcomes. Length of stay (LOS) is an important measure of surgical quality and efficiency in GS infants. LOS depends on clinical and patient-related factors such as simple (sGS) or complex (cGS), type of surgery, associated complications, and factors such as the use of standardized care protocols.

Objectives

To determine the annual trends in LOS for sGS and identify the predictors leading to these trends.

Methods/design

We conducted a retrospective cohort study of infants with sGS using the 2012–2022 NSQIP-Pediatrics dataset. Predictor variable for LOS was the year of admission divided into five groups. Demographics, preoperative risk factors, and postoperative complications and outcomes were collected.

Results

From 2012 to 2022, median LOS decreased by five days (30–25 days, p-value= <0.001). We also found that there was a decrease sGS cases in NSQIP dataset (0.34/100 to 0.16/100 infants, p-value= <0.001) was noted. There was an increasing percentage of sGS for Hispanic race, inborn, higher birthweight, and superficial incisional surgical site infection (sSSI), a trend towards increasing gestational age, but no differences in timing of surgery and unplanned readmission. Stratified Cox proportional model analysis revealed that gestational age of <36 weeks, bleeding/transfusions [Hazard Ratio (HR) = 0.53, p < 0.001] and nutritional support at discharge (HR = 0.27, p < 0.001) were associated with significantly longer LOS.

Conclusion

The trends in LOS reduction in sGS infants point towards higher birth weight, later gestational age and more optimal management. It underscores the importance of utilizing national registry databases to better understand the outcomes. Despite these improvements, the observed variations in demographics and outcomes indicate a need for standardized care protocols and a better understanding of the factors influencing LOS.

Level of Evidence

Level II.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.