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1.
Cristen N. Litz David J. Ciesla Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(3):446-448
Background
Teenagers receive appendicitis care at both adult and pediatric facilities. The purpose of this study was to evaluate outcomes following treatment of acute appendicitis in teenagers based on the type of hospital facility.Methods
Patients aged 13–17 years with acute appendicitis who were discharged from acute care hospitals from 2009 to 2014 were identified using a statewide discharge dataset. Hospitals were classified as pediatric or adult and outcomes were compared.Results
There were 5585 patients treated in adult hospitals and 1625 in pediatric hospitals. Fewer patients at adult hospitals had complicated appendicitis (20.4% vs. 33.0%, p < 0.01). Open appendectomy occurred more often in adult hospitals compared to pediatric hospitals (12.6% vs. 6.0%, p < 0.01). Pediatric hospitals had higher rates of non-operative management (10% vs. 3.4%, p < 0.01) and percutaneous drain placement (1.2% vs. 0.4%, p < 0.01). Postoperative complication rates did not significantly differ between hospital types.Conclusion
Most teenagers undergo appendectomy at adult facilities; however, a greater proportion of younger patients and patients with complicated appendicitis is treated at pediatric hospitals. Treatment at a freestanding children's hospital results in lower rates of open procedures and no difference in complications. Opportunities may exist to standardize care across treating facilities to optimize outcomes and resource use.Type of study
Prognosis study.Level of evidence
II. 相似文献2.
Ian C. Glenn Nicholas E. Bruns Oliver S. Soldes Todd A. Ponsky 《Journal of pediatric surgery》2018,53(8):1469-1471
Background
Post-operative antibiotics are often utilized for skin and soft tissue infection (SSTI) requiring surgical incision and drainage (I&D). We propose that antibiotics are unnecessary following I&D.Methods
Patients aged 3 months to 6 years with SSTI of the buttocks, groin, thigh, and/or labia requiring I&D were prospectively enrolled. The primary outcome was the proportion of patients requiring re-drainage and/or antibiotics for SSTI recurrence, within 30 days. Follow-up consisted of a 30-day phone call, with optional 2-week office visit, combined with chart review for patients lost to follow-up. A one-sample binomial proportion with 95% confidence interval (CI) was used to examine non-inferiority for rate of treatment success, using previously published success rates for patients receiving antibiotics post-operatively (95.9%, with a 7% margin of equivalence).Results
A total of 92 patients were enrolled. All patients received pre-operative antibiotics. There was one treatment failure (success rate 0.989, CI 0.941–0.999). The recurrence rate was noninferior to previously-published data for patients receiving postoperative antibiotics (p < 0.001). Subgroup analysis of patients who completed 30-day follow-up yielded a success rate of 0.973, CI 0.858–0.999 and evidence of non-inferiority (p = 0.04).Conclusions
Post-operative management excluding antibiotics should be considered for patients who undergo I&D for SSTI.Level of evidence
Level II (prospective cohort study with < 80% follow-up) 相似文献3.
Audrey L. Stokes Afif N. Kulaylat Dorothy V. Rocourt Christopher S. Hollenbeak Walter Koltun Tolulope Falaiye 《Journal of pediatric surgery》2018,53(7):1334-1338
Background
Pediatric Crohn's disease (CD) is increasing in incidence globally. Trends in specific types of inpatient pediatric CD-related surgical procedures have not been widely reported.Methods
Patients ≤ 20 years of age with CD were identified in the Kids' Inpatient Database for 2003, 2006, 2009, and 2012. Bowel resection, stoma creation, and perianal or percutaneous drainage procedures were identified using ICD-9 procedure codes, and trends were identified. Logistic regression was used to identify factors associated with surgical intervention and trends.Results
Rates of overall bowel resection (including ileocolic resection, other small bowel resection, or other colon resection) did not change significantly over time. However, the odds of having a laparoscopic colon resection increased by 41% annually (p < 0.001). Rates of subsequent ileostomy formation increased (odds ratio 1.09, p < 0.001). Older age, male sex, fewer comorbidities, and treatment in large urban teaching hospitals were also associated with higher odds of undergoing bowel resection.Conclusions
This study noted a stable rate of all types of bowel resections and increase in post resection ileostomy formation in US pediatric inpatients with CD from 2003–2012. Other rates of many CD-related procedures have remained stable. Further studies correlating the effects of biologic agents on surgical rates are warranted.Type of study
Treatment StudyLevel of evidence
Level III. 相似文献4.
Virginie Bussières Shreyas Roy Johnny Deladoey Élisabeth Rousseau Dickens St-Vil Nelson Piché 《Journal of pediatric surgery》2018,53(2):283-285
Aim of the study
The aim of the study was to evaluate the outcomes of prophylactic thyroidectomies performed in an academic setting in the context of multiple endocrine neoplasia type 2 (MEN2) syndrome.Methods
A chart review of patients < 18 years old who underwent prophylactic thyroidectomy for a MEN2 syndrome at a children's hospital between 2006 and 2015 was performed.Main results
The study included 21 patients (57% female) with a mean age of 6.2 ± 2.5 years. All patients were asymptomatic at first evaluation. Nineteen had MEN2A syndrome with RET proto-oncogene mutations identified. The remaining two were RET-negative with familial medullary thyroid cancer (FMTC). One patient had a concomitant Hirschsprung disease. Of the 11 patients who had RET proto-oncogene mutations ranked as Moderate Risk for medullary thyroid cancer (MTC) (American Thyroid Association), one had a microcarcinoma on the resected specimen, and the others had C-Cell Hyperplasia. Among the 8 patients who had RET proto-oncogene mutations ranked as High Risk level for MTC, all had microcarcinoma. Of the nine patients with microcarcinoma, three underwent surgery after 5 years of age. No microcarcinoma exceeded 6 mm. There were no permanent complications. Six patients experienced transient hypocalcemia, of which only one was symptomatic. No patients had lymph node involvement, and no recurrence was noted during the follow-up period.Conclusions
Of 21 children with familial thyroid cancer syndrome who underwent a prophylactic thyroidectomy, nine had microcarcinoma. This study highlights the need for a complete familial history, including FMTC history and mandatory preventive surgical approach.Level of evidence
III 相似文献5.
Cristen N. Litz Jessica B. Asuncion Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(3):449-451
Purpose
Antibiotic administration within one hour prior to incision is a common quality metric; however, antibiotics are typically started at the time of diagnosis in pediatric patients with acute appendicitis. The purpose was to determine if antibiotic administration within one hour prior to incision reduces the incidence of surgical site infections (SSI) in pediatric patients with acute appendicitis started on parenteral antibiotics upon diagnosis.Methods
A retrospective review was performed of 478 patients aged 0–18 years who underwent appendectomy for acute appendicitis from 7/2013 to 4/2015. Patients were categorized based on timing of antibiotic administration; there were 198 patients in Group A (< 60 min before) and 280 in Group B (> 60 min before).Results
Demographics and operative time (A: 30.5 ± 9.9 vs B: 30.8 ± 12.2 min, p = 0.51) were similar. Procedures were performed laparoscopically and the groups had similar proportions of single-incision operations (A: 53% vs B: 55%, p = 0.64). There was no difference in the incidence of superficial SSI (A: 2.0% vs B: 2.1%, p = 1.0) or intraabdominal abscess (A: 4.0% vs B: 3.6%, p = 0.81) and this remained true when stratified by intraoperative classification.Conclusion
Antibiotic administration within one hour of appendectomy in pediatric patients with acute appendicitis who receive antibiotics at diagnosis did not change the incidence of postoperative infectious complications.Type of study
Treatment study.Level of evidence
III. 相似文献6.
Guillermo J. Ares Irene Helenowski Catherine J. Hunter Marybeth Madonna Marleta Reynolds Timothy Lautz 《Journal of pediatric surgery》2018,53(4):704-707
Background
The utility of mechanical bowel preparation (MBP) to minimize infectious complications in elective colorectal surgery is contentious. Though data is scarce in children, adult studies suggest a benefit to MBP when administered with oral antibiotics (OAB).Methods
After IRB approval, the Pediatric Health Information System (PHIS) was queried for young children undergoing elective colon surgery from 2011 to 2014. Patients were divided into: no bowel preparation (Group 1), MBP (Group 2), and MBP plus OAB (Group 3). Statistical significance was determined using univariate and multivariate analysis with GEE models accounting for clustering by hospital.Results
One thousand five hundred eighty-one patients met study criteria: 63.7% in Group 1, 27.1% in Group 2, and 9.2% in Group 3. Surgical complication rate was higher in Group 1 (23.3%) compared to Groups 2 and 3 (14.2% and 15.5%; P < 0.001). However, median length of stay was shorter in Group 1 (4, IQR 4 days) compared to Group 2 (5, IQR 3) and Group 3 (6, IQR 3) (P < 0.001). 30-day readmission rates were similar. In multivariate analysis compared to patients in Group 1, the odds of surgical complications were 0.72 (95% CI 0.40–1.29, P = 0.28) with MBP alone (Group 2), 1.79 (95% CI 1.28–2.52, P = 0.0008) with MBP + OAB (Group 3), and 1.13 (95% CI 0.81–1.58, P = 0.46) for the aggregate Group 2 plus 3.Conclusion
Utilization of bowel preparation in children is variable across children's hospitals nationally, and the benefit is unclear. Given the discrepancy with adult literature, a three-armed pediatric-specific randomized controlled trial is warranted.Level of evidence
Level III treatment study – retrospective comparative study. 相似文献7.
Charlotte L. Kvasnovsky Kimberly Lumpkins Jose J. Diaz Jeannie Y. Chun 《Journal of pediatric surgery》2018,53(5):996-1000
Background
The American College of Surgeons has developed a verification program for children's surgery centers. Highly specialized hospitals may be verified as Level I, while those with fewer dedicated resources as Level II or Level III, respectively. We hypothesized that more specialized children's centers would utilize more resources.Study design
We performed a retrospective study of the Maryland Health Services Cost Review Commission (HSCRC) database from 2009 to 2013. We assessed total charge, length of stay (LOS), and charge per day for all inpatients with an emergency pediatric surgery diagnosis, controlling for severity of illness (SOI). Using published resources, we assigned theoretical level designations to each hospital.Results
Two hospitals would qualify as Level 1 hospitals, with 4593 total emergency pediatric surgery admissions (38.5%) over the five-year study period. Charges were significantly higher for children treated at Level I hospitals (all P < 0.0001). Across all SOI, children at Level I hospitals had significantly longer LOS (all P < 0.0001).Conclusion
Hospitals defined as Level II and Level III provided the majority of care and were able to do so with shorter hospitalizations and lower charges, regardless of SOI. As care shifts towards specialized centers, this charge differential may have significant impact on future health care costs.Level of Evidence
Level III Cost Effectiveness Study. 相似文献8.
Kibileri Williams Lauren Baumann Adil Shah Fizan Abdullah Emilie K. Johnson Tolulope A. Oyetunji 《Journal of pediatric surgery》2018,53(1):86-89
Purpose
Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18 months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level.Methods
We retrospectively reviewed both the State Ambulatory Surgery Database (SASD) in 2012 and the Pediatric Health Information System (PHIS) for 2015. All patients aged 18 years or less with a diagnosis of UDT who underwent orchiopexy were included. Demographic data including age at repair as well as surgical subspecialty and payer status were extracted.Results
Analysis of the 2012 SASD for New Jersey, Florida, and Maryland yielded 1654 patients. The majority were white, 791 (48.3%), with a median age at repair of 4 years (IQR 1–8). Most patients, 1048 (64%), had orchiopexy later than age 2. A total of 844 males were identified from the PHIS database. Of these, 63% were white. The median age at repair was 5 years (IQR 1–9). There were 577 (68%) patients older than 2 years at orchiopexy.Conclusion
Almost 70% of boys with undescended testes in the United States are undergoing orchiopexy at least 6 months later than the recommended age.Type of study
Retrospective.Level of evidence
III. 相似文献9.
Kristine S. Corkum Catherine J. Hunter Julia E. Grabowski Timothy B. Lautz 《Journal of pediatric surgery》2018,53(7):1295-1300
Background
Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children.Methods
Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained.Results
We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°.Conclusion
Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively.Level of evidence
Level IV. 相似文献10.
Heather L. Short Kurt F. Heiss Katelyn Burch Curtis Travers John Edney Claudia Venable Mehul V. Raval 《Journal of pediatric surgery》2018,53(4):688-692
Purpose
Enhanced recovery protocols (ERPs) have been shown to improve outcomes in adult surgical populations. Our purpose was to compare outcomes before and after implementation of an ERP in children undergoing elective colorectal surgery.Methods
A pediatric-specific colorectal ERP was developed and implemented at a single center starting in January 2015. A retrospective review was performed including 43 patients in the pre-ERP period (2012–2014) and 36 patients in the post-ERP period (2015–2016).Outcomes of interest included number of ERP interventions received, length of stay (LOS), complications, and readmissions.Results
The median number of ERP interventions received per patient increased from 5 to 11 from 2012 to 2016. The median LOS decreased from 5 days to 3 days in the post-ERP period (p = 0.01). We observed a simultaneous decrease in median time to regular diet, mean dose of narcotics, and mean volume of intraoperative fluids (p < 0.001). The complication rate (21% vs. 17%, p = 0.85) and 30-day readmission rate (23% vs. 11%, p = 0.63) were not significantly different in the pre- and post-ERP periods.Conclusions
Implementation of a pediatric-specific ERP in children undergoing colorectal surgery is feasible, safe and may lead to improved outcomes. Further experience may highlight other opportunities for increased compliance and improved care.Level of evidence
Treatment Study. Level III. 相似文献11.
Amparo Solé Casilda Olveira Ines Pérez David Hervás Vincent Valentine Anick N. Baca Yepez Gabriel Olveira Alexandra L. Quittner 《Journal of cystic fibrosis》2018,17(5):672-679
Background
The Cystic Fibrosis Questionnaire-Revised (CFQ-R + 14) is a disease-specific, health-related quality of life instrument for cystic fibrosis (CF) patients ≥ 14 years. We have developed a Spanish electronic version of the CFQ-R (e-CFQ-R + 14 Spain). Our aim was to compare the paper and electronic versions and to validate the electronic version.Methods
Fifty CF patients completed the study. All answered the paper and electronic versions on day 1 and repeated the e-CFQR version 15 days later.Results
Concordance between the electronic and paper copy versions was high, with correlations above 0.9 in all domains. Test-retest reliability of the e-CFQ-R results was strong, with coefficients ranging from 0.8 to 0.9.Conclusions
The e-CFQ-R version is reliable and valid and can replace the paper copy, thus simplifying the assessment of quality of life. It also provides immediate results with no errors in scoring. It is a useful new tool in CF care. 相似文献12.
Yasushi Fuchimoto Toshihiko Watanabe Akihiro Fujino Yutaka Kanamori Yushi Itoh Seiji Wada Haruhiko Sago Takako Yoshioka 《Journal of pediatric surgery》2018,53(12):2386-2389
Purpose
The purpose of this study was to clarify the relationship between congenital pulmonary airway malformation volume ratio (CVR) of bronchial atresia (BA), CVR of congenital cystic adenomatoid malformations (CCAM), and time of surgery after birth.Method
We retrospectively analyzed data of 36 BA and CCAM cases, prenatally diagnosed as CPAM from 2009 through 2014.Results
Within 2?h after birth, 12 neonatal patients underwent emergent (EMG) lobectomy. Five cases of lobectomy were performed urgently (UG) from 12 to 48?h after birth. Four cases of lobectomy were required within 30?days after birth (early?=?EAG). We performed lobectomy in 15 other patients at 11?months after birth (late?=?LG). Of the EMG cases, 11 were macrotype CCAM (maximal CVR > 2.0), and 4 of 5 UG cases were microtype CCAM (CVR > 2.0). Of the EAG cases, 3 of 4 were macrotype CCAM with CVR of < 1.5. Of 15 LG, 13 were BA and showed a CVR of 0.13–3.0 (median, 0.78). The CVR of the cases operated on within 48?h after birth was significantly larger than that of the cases operated on after 2?weeks (p?=?0.001).Conclusion
EMG or UG lobectomy was usually required after birth in CCAM, indicating maximal CVR > 2.0. By contrast, elective surgery was performed in most BA cases.Level of evidence
IV. 相似文献13.
Cory N. Criss Ninette Musili Niki Matusko Scott Baker James D. Geiger Shaun M. Kunisaki 《Journal of pediatric surgery》2018,53(6):1092-1097
Introduction
The purpose of this study was to evaluate clinical outcomes in children with asymptomatic congenital lung malformations (CLM) who were initially managed nonoperatively.Methods
An IRB-approved retrospective review was performed on all CLMs at a single tertiary care referral center (Jan 2006–Dec 2016, n = 140). Asymptomatic cases that did not undergo elective resection were evaluated for subsequent CLM-related complications based on clinical records and a telephone quality of life survey.Results
Out of 39 (27.9%) who were initially managed nonoperatively, 13 (33%) developed CLM-related symptoms and underwent surgical intervention at a median age of 6.8 years (range, 0.7–19.8 years). The most common indication for conversion to operative management was pneumonia (78%). Larger lesions, as measured by CT scan, were significantly associated with the need for subsequent surgical intervention (mean maximal diameter, 5.7 vs. 2.9 cm; p = 0.005). Based on survey data with a median follow up of 3.9 years (range, 0.2–13.2 years), 17% developed chronic pulmonary symptoms, including cough (11%) and asthma requiring bronchodilators (12%).Conclusion
Although these data support nonoperative management as a viable alternative to surgical resection, at least one-third of CLM children eventually develop pneumonia or other pulmonary symptoms. Larger lesions are correlated with an increased risk for eventual surgical resection.Level of Evidence
Level IV. 相似文献14.
Background
Infection in low flow malformations is difficult to diagnose and treat. Initial presentation can be followed by cycles of recurrent infection lasting several years. The optimal duration of antibiotic therapy to prevent recurrence of infection has not been established.Methods
All cases of infection in low flow malformations at the Royal Children's Hospital over a ten-year period were reviewed. Clinical markers of infection and duration of initial antibiotic treatment were correlated with the development of recurrent episodes of infection.Results
Twenty-one patients met criteria for inclusion. Nineteen were diagnosed as lymphatic malformations and two as venous malformations. The majority of patients (13 or 62%) received a prolonged course of six weeks or more of antibiotics. Eleven (52%) patients went on to have recurrent infections, but these were significantly less likely to be in those treated with a long course of antibiotics (Fisher's exact test, p = 0.026). In only 12 of 21 cases could a bacterium be grown. Elevated CRP was the most consistent abnormal laboratory finding in infection.Conclusions
Longer courses of antibiotics reduce the risk of recurrent infection in low-flow vascular malformations. We recommend an antibiotic course of three months or more at the initial presentation of infection in a low flow malformation. Elevated CRP is the most sensitive test for diagnosis of infection in low-flow malformations.Type of study
Treatment study.Level of evidence
III. 相似文献15.
Neema Kaseje Hillary Jenny Andre Patrick Jeudy Jean Louis MacLee John G. Meara Henri R. Ford 《Journal of pediatric surgery》2018,53(2):298-301
Purpose
Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region.Materials/methods
A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research.Results
Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children < 15 years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children < 4 years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n = 4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors.Conclusions
Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision.Level of evidence
III 相似文献16.
Chenghao Chen Qi Zeng Zhongzhi Li Na Zhang Jie Yu 《Journal of pediatric surgery》2018,53(9):1855-1857
Objective
To measure the force required for correcting pectus carinatum to the desired position and investigate the correlations of the required force with patients’ gender, age, deformity type, severity and body mass index (BMI).Methods
A total of 125 patients with pectus carinatum were enrolled in the study from August 2013 to August 2016. Their gender, age, deformity type, severity and BMI were recorded. A chest wall compressor was used to measure the force required for correcting the chest wall deformity. Multivariate linear regression was used for data analysis.Results
Among the 125 patients, 112 were males and 13 were females. Their mean age was 13.7 ± 1.5 years old, mean Haller index was 2.1 ± 0.2, and mean BMI was 17.4 ± 1.8 kg/m2. Multivariate linear regression analysis showed that the desirable force for correcting chest wall deformity was not correlated with gender and deformity type, but positively correlated with age and BMI and negatively correlated with Haller index.Conclusions
The desirable force measured for correcting chest wall deformities of patients with pectus carinatum positively correlates with age and BMI and negatively correlates with Haller index. The study provides valuable information for future improvement of implanted bar, bar fixation technique, and personalized surgery.Type of study
Retrospective study.Level of evidence
Level 3–4. 相似文献17.
Verena Ellerkamp Andreas Schmid Gunnar Blumenstock Georg Hrivatakis Wolfgang Astfalk Steffan Loff Joerg Fuchs Sabine Zundel 《Journal of pediatric surgery》2018,53(11):2219-2224
Background
Early orchidopexy (OP) around the age of 1 year is recommended in boys with congenital undescended testis (UDT) worldwide since decades. Former retrospectives studies did not distinguish congenital from acquired UDT with a consecutive negative bias concerning the age at surgery.Methods
In a retrospective analysis, data of all boys who underwent OP in eight pediatric surgery institutions from 2009 to 2015 were analyzed. Congenital or acquired UDT were differentiated. Patients were categorized into 3 groups of age at surgery: (1) < 12?months, (2) 12–24?months, (3) > 24?months. Data of one institution were analyzed in detail: exact age of first referral, exact age at surgery, intraoperative findings.Results
Out of 4448 boys, 3270 boys had congenital UDT. In 81% (2656 cases) surgery was performed beyond the age of 1 year, in 54.4% (1780) beyond the age of 2 years. chi-Square statistics showed a higher rate of early operations in hospitals compared to outpatient services and in Germany compared to Switzerland. In 694 congenital detailed cases, median age at referral was 13?months [range 0–196], median age at surgery was 15?months [range 0–202].Conclusion
Delayed referral is the main reason for guideline non-conform delayed surgery in UDT.Type of Study
Clinical Research paper.Level of evidence
Level III: Treatment Study. 相似文献18.
Robert J. Obermeyer Nina S. Cohen Sheema Gaffar Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson 《Journal of pediatric surgery》2018,53(6):1226-1229
Background/Purpose
Our previously published data suggested several risk factors for infection after the Nuss procedure. We aimed to further elucidate these findings.Methods
An IRB-approved (14–03-WC-0034), single institution, retrospective review was performed to evaluate the incidence of postoperative Nuss bar infections associated with seven variables. These were subjected to bivariate and multivariable analyses. A broad definition of infection was used including cellulitis, superficial infection with drainage, or deep infection occurring at any time postoperatively.Results
Over 7 years (4/1/2009–7/31/2016), 25 (3.2%) of 781 patients developed a postoperative infection after primary Nuss repair. Multivariable analyses demonstrated an increased risk of infection with perioperative clindamycin versus cefazolin for all infections (AOR 3.72, p = .017), and specifically deep infections (AOR 5.72, p = .004). The risk of a superficial infection was increased when antibiotic infusion completed > 60 min prior to incision (AOR 10.4, p = .044) and with the use of peri-incisional subcutaneous catheters (OR 8.98, p = .008).Conclusion
Following primary Nuss repair, the rate of deep bar infection increased with the use of perioperative clindamycin rather than cefazolin. The rate of superficial infection increased when perioperative antibiotic infusion was completed more than 60 min prior to incision and with the use of peri-incisional subcutaneous catheters. Further studies are needed to better understand these findings.Type of study
Retrospective chart review.Level of evidence
Level III treatment study. 相似文献19.
James M. Roberts Darlene L.Y. Dai Zsuzsanna Hollander Raymond T. Ng Scott J. Tebbutt Pearce G. Wilcox Don D. Sin Bradley S. Quon 《Journal of cystic fibrosis》2018,17(3):333-340
Background
Systemic inflammation decreases with IV antibiotics during the treatment of CF pulmonary exacerbations (PEx). We used multiple reaction monitoring mass spectrometry and immunoassays to monitor blood proteins during PEx treatment to determine if early changes could be used to predict PEx outcomes following treatment.Methods
Blood samples from 25 PEx (22 unique adults) were collected within 24 h of admission, day 5, day 10, and at IV antibiotic completion. Ninety-two blood proteins involved in host immunity and inflammation were measured.Results
Levels of several blood proteins changed from admission to end of IV antibiotics, most increasing with treatment. Early changes (admission to day 5) in fibrinogen levels had the strongest correlation with overall improvement in CFRSD-CRISS and FEV1% predicted by the end of treatment.Conclusions
Several plasma proteins changed significantly with IV antibiotics. Future studies will evaluate fibrinogen as an early biomarker of PEx treatment response in CF. 相似文献20.