改善鞘内巴氯芬泵手术后预后的术前胃肠优化方案。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Amanda M Mosher, Emma K Hartman, Marcella Ruppert-Gomez, Steven J Staffa, Kristin Buxton, Ann Morgan, Sangeeta Muskar, Scellig Stone, Weston T Northam
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引用次数: 0

摘要

目的:小儿脑瘫患者在神经外科手术后经常出现合并症并不成比例地消耗医院资源。我们实施了一项制度性的术前胃肠道(GI)优化方案,以改善预后并减少资源利用率。方法:根据2017年7月1日方案实施情况,对2000年至2023年所有323例鞘内巴氯芬手术进行分类。比较结果和资源利用情况。结果:方案的改变显著减少了因便秘再入院的人数(p = 0.001),消除了便秘和gi相关的急诊就诊。与便秘相关的再入院减少了27个住院日(平均每位患者1天,IQR为1,2天)。实验组之间没有差异,包括人口统计学或胃肠道合并症。术后30天内的并发症在尿路感染、手术部位感染和脊髓液泄漏方面组间具有可比性。两组患者术后住院时间差异无统计学意义。结论:GI优化方案可以消除巴氯芬泵手术后再入院和GI相关急诊就诊的频繁来源,甚至考虑到基线GI合并症。预防再入院和急诊可降低医院资源利用率,提高护理质量。未来的努力是必要的,以改善结果和护理效率为我们最复杂的和资源密集型患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A pre-operative gastrointestinal optimization protocol to improve outcomes after intrathecal baclofen pump surgery.

Purpose: Pediatric cerebral palsy patients carry frequent medical comorbidities and disproportionately consume hospital resources after neurosurgical procedures. We implemented an institutional pre-operative gastrointestinal (GI) optimization protocol to improve outcomes and decrease resource utilization.

Methods: All 323 intrathecal baclofen surgeries from 2000 to 2023 were categorized relative to protocol implementation on July 1, 2017. Outcomes and resource utilization were compared.

Results: The protocol change resulted in significantly fewer hospital readmissions (p = 0.001) for constipation, eliminating them and GI-related emergency visits. There was a reduction of 27 hospital days for constipation-related readmission (median 1 day per patient, IQR 1, 2 days). No differences were reported between the experimental groups including demographics or GI comorbidities. Post-operative complications within 30 days were comparable between groups regarding urinary tract infections, surgical-site infections, and spinal fluid leak. There were no differences in post-operative length of stay between groups.

Conclusion: A GI optimization protocol can eliminate a frequent source of hospital readmissions and GI-related emergency department visits after baclofen pump surgery, even accounting for baseline GI comorbidities. Preventing readmissions and emergency visits translates to lower hospital resource utilization and improves quality of care. Future efforts are warranted to improve outcomes and care efficiency for our most complex and resource-intensive patients.

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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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