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1.
Saurabh Saluja Tianyi Sun Jialin Mao Shaun A. Steigman P. Stephen Oh Heather L. Yeo Art Sedrakyan Demetri J. Merianos 《Journal of pediatric surgery》2018,53(7):1339-1344
Background
Complicated appendicitis is common in children, yet the timing of surgical management remains controversial. Some support initial antibiotics with delayed operation whereas others support immediate operation. While a few randomized trials have evaluated this question, they have been small, single-center trials with limited follow-up. We present a database analysis of outcomes in early versus late surgical management of complicated appendicitis with one-year follow-up.Methods
We conducted a retrospective review of children with complicated appendicitis presenting between 2000 and 2013, utilizing a New York State database. We compare children undergoing later versus early appendectomy with a primary outcome measure of any complication within one year as determined from ICD-9 codes.Results
8840 children were included in the analysis, 7708 of whom underwent early appendectomy. Patients with late appendectomy were significantly more likely to have at least one complication when compared to those undergoing early appendectomy (34.6% vs 26.7%, p < 0.01).Conclusions
We present the first population-level study evaluating early versus late appendectomy in children with complicated appendicitis with a one-year follow-up period. Children undergoing late appendectomy were more likely to have a complication than those undergoing early appendectomy. These data corroborated previous studies supporting early operative management.Level of evidence
This study provides level III evidence of a treatment study. 相似文献2.
Steven L. Lee Lara Spence Kyle Mock James X. Wu Huan Yan Daniel A. DeUgarte 《Journal of pediatric surgery》2018,53(1):42-47
Background
Carefully selected children with early appendicitis may be managed nonoperatively. However, it is unknown whether nonoperative management (NOM) is applicable to all patients with uncomplicated appendicitis. The purpose of this study was to evaluate the outcomes of NOM of uncomplicated appendicitis with expanded inclusion criteria.Methods
A prospective, nonrandomized patient-preference study comparing NOM versus laparoscopic appendectomy (LA) was performed in children with radiographic/clinical evidence of uncomplicated appendicitis.Results
Demographics, laboratory values, and clinical presentation were similar between the NOM (n = 51) and LA (n = 32) groups. Initial failure rate was 31%. The outcomes were similar between groups, except that NOM had fewer days of pain medication. Patients who failed NOM had a longer duration of symptoms prior to admission. Patients with appendicolith had a failure rate of 50% compared to 24% without appendicolith. The recurrence rate was 26%. Overall, 51% avoided appendectomy. Costs were similar between NOM and LA.Conclusions
When expanding the inclusion criteria for children with presumed uncomplicated appendicitis, NOM was associated with high failure and recurrence rates. These high rates may be because of the inclusion of patients with complicated appendicitis and patients with an appendicolith. Even in this setting of less-restrictive exclusion criteria, NOM remained cost neutral.Level of evidence
LEVEL II (Treatment Study: Prospective Comparative Study). 相似文献3.
Tishara Wijayanayaka Jacob Davidson Andreana Bütter 《Journal of pediatric surgery》2018,53(5):980-983
Purpose
The purpose of this study was to determine whether children with a positive ultrasound (US) for acute appendicitis but a negative clinical picture developed appendicitis requiring definitive management.Methods
After obtaining IRB approval, we conducted a retrospective review of patients ≤ 17 years who presented with possible acute appendicitis between April 1st, 2014, and December 31st, 2015. We included patients with a US suggestive of acute appendicitis based on size criteria but without concerning clinical features. Patients were discharged from the emergency department (ED) or admitted for observation. Variables included demographic data, US characteristics, clinical findings, length of follow-up, and appendectomy.Results
Of the 31 patients identified, 45% were male and average age was 11.3 yrs. On US, the average maximal diameter of the appendix was 6.93 mm. The median length of follow-up was 16.8 months, including 10 returns to the ED by 9 patients. Three of these underwent immediate laparoscopic appendectomy, while one had interval appendectomy. There were no cases of perforated appendicitis, and only 2 cases demonstrated pathology consistent with appendicitis.Conclusion
These findings demonstrate that it is safe to consider conservative measures such as observation or discharge in children with a positive US for appendicitis based on size criteria but a negative clinical picture.Level of Evidence
4 相似文献4.
Danielle B. Cameron Regan Williams Yimin Geng Ankush Gosain Meghan A. Arnold Yigit S. Guner Martin L. Blakely Cynthia D. Downard Adam B. Goldin Julia Grabowski Dave R. Lal Roshni Dasgupta Robert Baird Robert L. Gates Julia Shelton Tim Jancelewicz Shawn J. Rangel Mary T. Austin 《Journal of pediatric surgery》2018,53(3):396-405
Objective
The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction.Methods
The committee selected three questions that were addressed by searching MEDLINE, Embase, and the Cochrane Library databases for English language articles published between January 1, 1970 and November 3, 2016. Consensus recommendations for each question were made based on the best available evidence for both children and adults.Results
Based on level 3–4 evidence, appendectomy performed within 24 h of admission in patients with acute appendicitis does not appear to be associated with increased perforation rates or other adverse events. Based on level 4 evidence, time from admission to appendectomy within 24 h does not increase hospital cost or length of stay (LOS). Data are currently limited to determine an association between the timing of appendectomy and parent/patient satisfaction.Conclusions
There is a paucity of high-quality evidence in the literature regarding timing of appendectomy for patients with acute appendicitis and its association with adverse events or resource utilization. Based on available evidence, appendectomy performed within the first 24 h from presentation is not associated with an increased risk of perforation or adverse outcomes.Type of study
Systematic Review of Level 1–4 studies 相似文献5.
6.
Background
The conventional paradigm that all children with appendicitis require an appendectomy is being challenged by the idea that some patients may be successfully managed non-operatively. The study aimed to determine if matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) are candidate biomarkers for estimating the probability of complicated appendicitis in pediatric patients.Methods
The study was a single-institution, prospective cohort study. MMP and TIMP serum protein concentrations were measured in patients with suspected appendicitis. Three hundred and thirty-one patients were enrolled with appendicitis. Classification and Regression Tree (CART) analysis was used to determine the combination of candidate biomarkers that best predicted complicated appendicitis.Results
The CART-generated decision tree for the derivation cohort included WBC count, MMP-8, MMP-9, MMP-12, TIMP-2, and TIMP-4 and had the following test characteristics for estimating the probability of complicated appendicitis (95% CI): AUC 0.86 (0.81–0.90); sensitivity 91% (83–96); specificity 61% (53–68); positive predictive value 58% (50–66); negative predictive value 92% (84–96); positive likelihood ratio (LR) 2.3 (1.9–2.8); and negative LR 0.15 (0.08–0.3).Conclusions
MMPs and TIMPs have the potential to serve as biomarkers to estimate the probability of complicated appendicitis in pediatric patients. The multi-biomarker-based decision tree has test characteristics suggesting clinical utility for decision making.Level of Evidence
Level II: Study of Diagnostic Test. 相似文献7.
Kristin Gee Sandra Ngo Lorrie Burkhalter Alana L. Beres 《Journal of pediatric surgery》2018,53(5):988-990
Background
Appendicitis is the most common gastrointestinal pediatric surgical emergency. With the introduction of laparoscopic techniques in the 1990s, recovery, pain, and hospital stay after laparoscopic procedures have been significantly reduced. While many laparoscopic procedures are performed as outpatient surgeries, pediatric appendectomy patients continue to be hospitalized for postoperative observation. Our goal was to evaluate the safety and feasibility of same day discharge after laparoscopic appendectomy for uncomplicated appendicitis.Methods
After IRB approval, all pediatric patients undergoing laparoscopic appendectomy during 2016 for noncomplicated appendicitis were eligible for the study. Decision for same day discharge was based on surgeon preference and parental agreement. Data regarding demographics, admission and discharge times, outcomes of complications, readmissions, return to the ED, and nonscheduled clinic visits were collected.Results
A total of 1321 appendectomies were performed during the study period, of which 849 were uncomplicated and 382 were discharged same day. There were 2 readmissions, 4 superficial surgical site infections, 10 patients with nausea or vomiting, and 33 patients with pain control issues, 9 of whom presented to the ED.Conclusions
Same day discharge for laparoscopic noncomplicated appendectomy is a safe and feasible alternative to postoperative admission and observation. This has the potential to yield significant healthcare cost savings.Level of Evidence
Level II, Prospective Cohort Study. 相似文献8.
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9.
Steve M.M. de Castro Thijs H. Geerdink Sven Macco Ruben N. van Veen Sebastiaan Jensch Bart C. Vrouenraets 《Journal of pediatric surgery》2018,53(10):2028-2031
Objective
In children, the diagnosis “acute appendicitis” is difficult. In 2010, a new Dutch appendicitis guideline was published with the goal to reduce the negative appendectomy rate. The guideline recommended mandatory imaging (ultrasound first and CT or MRI when inconclusive) before surgery. This study examines whether the negative appendectomy rate in children has declined after the implementation of the guideline and if the number of ionising imaging procedures increased.Methods
In this cohort study, all consecutive patients aged 17 or younger, with the suspicion of appendicitis were included. Patients were divided into two groups. Those who presented between 2006 and 2010 (before the implementation) and those between 2011 and 2016 (after implementation).Results
In total, 748 children were enrolled, of which 363 children were seen before and 385 children after implementation of the guideline. Before implementation, 46% of the children with acute appendicitis underwent preoperative ultrasound compared with 95% in the post implementation group, p < 0.001. Any imaging was performed in 51% and 100%, respectively, p < 0.001. The percentage of negative appendectomy before implementation was 13% and 2.7% after implementation, p < 0.001. There was no significant increase in the number of CT scans before and after the implementation of the guideline, 3.6% versus 6.0%, respectively, p = 0.126. There was no increase in direct medical costs.Conclusions
Mandatory preoperative imaging in children with the suspicion of acute appendicitis results in a significant decrease in negative appendectomies with no increase in the number of CT scans and without a substantial increase in costs.Level of Evidence
III. 相似文献10.
Jamie R. Robinson Nicholas H. Carter Corinne Gibson Adam S. Brinkman Kyle Van Arendonk Karen E. Speck Melissa E. Danko Gretchen P. Jackson Harold N. Lovvorn Martin L. Blakely 《Journal of pediatric surgery》2018,53(6):1181-1186
Purpose
Standardized care via a unified surgeon preference card for pediatric appendectomy can result in significant cost reduction. The purpose of this study was to evaluate the impact of cost and outcome feedback to surgeons on value of care in an environment reluctant to adopt a standardized surgeon preference card.Methods
Prospective observational study comparing operating room (OR) supply costs and patient outcomes for appendectomy in children with 6-month observation periods both before and after intervention. The intervention was real-time feedback of OR supply cost data to individual surgeons via automated dashboards and monthly reports.Results
Two hundred sixteen children underwent laparoscopic appendectomy for non-perforated appendicitis (110 pre-intervention and 106 post-intervention). Median supply cost significantly decreased after intervention: $884 (IQR $705–$1025) to $388 (IQR $182–$776), p < 0.001. No significant change was detected in median OR duration (47 min [IQR 36–63] to 50 min [IQR 38–64], p = 0.520) or adverse events (1 [0.9%] to 6 [4.7%], p = 0.062). OR supply costs for individual surgeons significantly decreased during the intervention period for 6 of 8 surgeons (87.5%).Conclusion
Approaching value measurement with a surgeon-specific (rather than group-wide) approach can reduce OR supply costs while maintaining excellent clinical outcomes.Level of Evidence
Level II. 相似文献11.
Punam P. Parikh Jun Tashiro Amy E. Wagenaar Miosotys Curbelo Eduardo A. Perez Holly L. Neville Anthony R. Hogan Juan E. Sola 《Journal of pediatric surgery》2018,53(4):616-619
Background
Appendiceal ligation during pediatric laparoscopic appendectomy (LA) may be performed using looped suture versus stapler. Controversy regarding the utility of either method exists. Clinical outcomes and cost analysis of LA with both methods were compared.Methods
All pediatric LA were performed from fiscal years 2013 and 2014 by two pediatric surgeons. While one surgeon used looped suture, the other used stapler exclusively. chi-Square tests were performed to analyze associations.Results
Two hundred thirty-eight cases were analyzed where looped suture versus stapler LA was performed in 46% and 54% of patients, respectively. Operating room costs were $317.10 and $707.12/person for looped suture and stapler LA, respectively (P < 0.0001). Difference in cost of $390.02/person was attributed solely to ligation type. On bivariate analysis, rate of in-hospital complications, length of stay, return-to-ER and readmission within 30 days did not significantly differ between groups.Conclusion
A comparative analysis of looped suture versus stapler device during LA for pediatric appendicitis revealed that postoperative complications, length of stay, ER visits and readmissions were not significantly different. Looped suture LA was significantly more cost efficient than stapler LA. In pediatric appendicitis, appendiceal ligation during LA may be performed safely and cost effectively with looped suture versus stapler.Type of study
Cost effectivenessLevel of evidence
III. 相似文献12.
Yangyang R. Yu Richard Sola Somala Mohammed Joshua T. Lackey Sheena John Eric Rosenfeld Wei Zhang Shawn D. St. Peter Sohail R. Shah 《Journal of pediatric surgery》2018,53(10):2032-2035
Background
Patient-controlled analgesia (PCA) is often used in children with perforated appendicitis. To prevent urinary retention, some providers also routinely place Foley catheters.This study examines the necessity of this practice.Methods
We retrospectively reviewed all children (≤ 18?years old) with perforated appendicitis and postoperative PCA from 7/2015 to 6/2016 at two academic children's hospitals. Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley catheter.Results
Of 313 patients who underwent appendectomy for perforated appendicitis (Hospital 1: 175, Hospital 2: 138), 129 patients received an intraoperative Foley (Hospital 1: 22 [13%], Hospital 2: 107 [78%], p?<?0.001). Age, gender, and BMI were similar between those with an intraoperative Foley and those without. There were no urinary tract infections in either group.Urinary retention rate in patients with an intraoperative Foley following removal on the inpatient unit (n?=?3, 2%) and patients without an intraoperative Foley (n?=?10, 5%) did not reach significance (p?=?0.25). On univariate analysis, demographics, intraoperative findings, PCA specifics, postoperative abscess formation, and postoperative length of stay, were not significant risk factors for urinary retention.Conclusions
The risk of urinary retention in this population is low despite the use of PCA. Children with perforated appendicitis do not require routine Foley catheter placement to prevent urinary retention.Level of evidence
II 相似文献13.
William Bonadio Syeda Shahid Lior Vardi Carly Buckingham Allison Kornblatt Chloe Free Peter Homel 《Journal of pediatric surgery》2018,53(3):441-445
Importance
Appendicitis is a common, potentially serious pediatric disease. An important factor in determining management strategy [whether/when to perform appendectomy, duration of antibiotic therapy/hospitalization, etc.] and predicting outcome is distinguishing whether perforation is present.Objective
The objective was to determine efficacy of commonly assessed pre-operative variables in stratifying perforation risk in children with appendicitis.Design
A retrospective analysis of consecutive cases was performed.Setting
The setting was a large urban hospital pediatric emergency department.Participants
Four hundred forty-eight consecutive cases of CT [computerized tomography]-confirmed pediatric appendicitis during a 6-year period in an urban pediatric ED [emergency department]: 162 with perforation and 286 non-perforated.Main outcome(s) and measure(s)
To determine efficacy of clinical and laboratory variables with distinguishing perforation outcome in children with appendicitis.Results
Regression analysis identified 3 independently significant variables associated with perforation outcome – and determined their ideal threshold values: duration of symptoms > 1 day; ED-measured fever [body temperature > 38.0 °C]; CBC WBC absolute neutrophil count > 13,000/mm3. The resulting multivariate ROC [receiver operating characteristic] curve after applying these threshold values gave an AUC [area under curve] of 89% for perforation outcome [p < 0.001]. Risk for perforation was additive with each additional predictive variable exceeding its threshold value, linearly increasing from 7% with no variable present to 85% when all 3 variables are present.Conclusions
A pre-operative scoring system comprised of 3 commonly assessed clinical/laboratory variables is useful in stratifying perforation risk in children with appendicitis.Physicians can utilize these factors to gauge pre-operative risk for perforation in children with appendicitis, which can potentially aid in planning subsequent management strategy.Level of evidence
III. 相似文献14.
Aurelian Binet Karim Braïk Francois Lengelle Marc Laffon Hubert Lardy Sarah Amar 《Journal of pediatric surgery》2018,53(11):2322-2325
Background
Appendectomy is a well-established surgical procedure in pediatric surgery used in the management of acute appendicitis. With the continuous advancement in the field of minimal invasive surgery, the recent focus is on single incision laparoscopic (SIL) surgery. SILA also goes further in order to decrease pain, improve recovery and enhance patient satisfaction. However, this approach is still not a well-established technique and not widely practiced, especially in pediatric surgery.Methods
We prospectively recorded the data in our pediatric universitary hospital center since January, 01 2017 to July, 01 2017. Patients included in this study were randomized in two groups: SILA group (managed by one-port laparoscopy, n = 40) and LA group (conventional laparoscopy using three trocars, n = 40).Results
The mean operative time for SILA was significantly lower. There were no postoperative complications in SILA group. If peritonitis was associated with appendicitis, the operative duration was not significantly different between each group. The duration in recovery room after surgery was significantly lower in SILA group. The morphine consumption was significantly lower for SILA group according to patient weight. SILA is less painful significantly than CLA for the first postoperative 6 h. After, even if SILA appears less painful, difference is not significant. The hospital length of stay was significantly higher in LA than SILA groupConclusions
SILA procedure for appendectomy appears to be safe and efficient for appendicitis management in children. This technique could be applied in routine as in emergency tome.Type of study
Prospective comparative studyLevel of evidence
II 相似文献15.
Yasmine Yousef Fouad Youssef Michael Homsy Trish Dinh Hayden Stagg Robin Petroze Robert Baird Jean-Martin Larberge Dan Poenaru Pramod Puligandla Kenneth Shaw Sherif Emil 《Journal of pediatric surgery》2018,53(5):991-995
Background
Total parenteral nutrition (TPN) is often used in children with perforated appendicitis, despite the absence of clear indications. We assessed the validity of specific clinical indications for initiation of TPN in this patient cohort.Methods
Data were gathered prospectively on duration of nil per os (NPO) status and TPN use in a cohort of children treated under a perforated appendicitis protocol during a 19-month period. TPN was started in the immediate postoperative period in patients who had generalized peritonitis and severe intestinal dilatation at operation, or later per the discretion of the attending surgeon. At discharge, TPN was considered to have been used appropriately, according to consensus guidelines, if the patient was NPO ≥ 7 days or received TPN ≥ 5 days.Results
During the study period, TPN was initiated in 31 (25.4%) of 122 patients operated for perforated appendicitis. Sixteen (51.6%) received TPN per operative finding indications and 15 (48.4%) for prolonged ileus. The operative indications demonstrated 47% sensitivity, 86% specificity, a positive predictive value (PPV) of 35%, and a negative predictive value (NPV) of 91%, when adherence to TPN consensus guidelines was considered the gold standard.Conclusion
Patients without severe intestinal dilatation and generalized peritonitis at operation should not be placed on TPN in the immediate postoperative period. Refinement of selection criteria is necessary to further decrease inappropriate TPN use in children with perforated appendicitis.Type of study
Diagnostic Test.Level of study
II 相似文献16.
Moya Vandeleur Lisa M. Walter David S. Armstrong Philip Robinson Gillian M. Nixon Rosemary S.C. Horne 《Journal of cystic fibrosis》2018,17(6):811-820
Background
We aimed to investigate the relationship between sleep quality, mood and health-related quality of life (HRQOL) in children with CF and controls.Methods
Children (7–12 years) and adolescents (13–18 years) with CF and controls completed sleep evaluation: overnight oximetry and 14 days of actigraphy. Age-appropriate questionnaires assessed mood (Children's Depression Inventory; CDI or Beck's Depression Inventory), HRQOL (CF Questionnaire-Revised; CFQ-R or PedsQL), and sleepiness (Pediatric Daytime Sleepiness Scale).Results
87 CF and 55 controls recruited. Children with CF had poorer sleep quality, more sleepiness and lower mood than controls, with a negative correlation between mood score and sleep efficiency. Sleepiness score was predictive of mood score and multiple CFQ-R domains. Adolescents with CF also demonstrated poorer sleep and more sleepiness than controls, but no difference in mood. Reduced sleep quality predicted lower CFQ-R scores. No correlation between sleep, mood or HRQOL in controls.Conclusions
In children and adolescents with CF, impaired sleep quality is associated with lower mood and HRQOL in an age-specific manner. Future research will aid understanding of effective strategies for prevention and treatment of mood disorders and sleep disturbance in children with CF. 相似文献17.
Soundappan SV Soundappan Jonathan Karpelowsky Albert Lam Lawrence Lam Danny Cass 《Journal of pediatric surgery》2018,53(10):2023-2027
Aim
Compare the diagnostic accuracy of surgeon performed ultrasound to radiology performed ultrasound in children presenting with suspected appendicitis to a tertiary care pediatric hospital in Australia.Methods
Children under 16 presenting to the emergency department of The Children's Hospital at Westmead were considered for the study. Patients with obvious signs of appendicitis not requiring ultrasound and those with established ultrasound diagnosis of appendicitis were excluded. Ultrasound was performed by a Pediatric Surgeon (SPU) after obtaining consent. The treating team was blinded to the results. Patient underwent formal ultrasound in radiology (RPU) and treatment was based on the formal report. SPU result was reviewed by a radiologist blinded to results of RPU. The results were compared.Results
65 children underwent ultrasound. 35 were male. Median age was 10 (range3–15). Median weight was 36 kg (range 12.6–76.2 kg), z-score median 0.21 (? 1.83 to 2.74). Symptom duration ranged from few hours to 2?weeks but majority (45) had symptoms for less than 48?h. Prevalence of appendicitis was 45%. Thirty two underwent surgery. Negative appendicectomy rate was 9.4%. Thirty three did not have surgery. 8 represented but only one proceeded to appendicectomy. SPU was done earlier than RPU (median 12?h vs 14.15?h) p?=?0.088. Diagnostic accuracy using ROC did not reveal significant difference.Conclusion
SPU can be performed earlier than RPU with reliable accuracy. Training surgical trainees will enable early diagnosis and management of appendicitis. 相似文献18.
Lisa M. Soler Steven L. Raymond Shawn D. Larson Janice A. Taylor Saleem Islam 《Journal of pediatric surgery》2018,53(10):1960-1963
Purpose
The management of primary spontaneous pneumothorax (PSP) in the pediatric population is not standardized. The purpose of this study was to understand the management options for a first episode of PSP in children and adolescents, and their associated outcomes.Methods
A retrospective study was conducted for patients 5–20 years old with a diagnosis of PSP at a large academic children’s hospital between 2002 and 2014. Patient data were reviewed for each case. Management and outcomes were analyzed and compared between groups.Results
Eighty patients met all inclusion criteria. Overall recurrence rate was 40% with 86% occurring within 12 months of the initial PSP. Patients with recurrent PSP were significantly taller. Size of pneumothorax based on initial chest x-ray was comparable between recurrent and nonrecurrent groups. A negative CT scan for subpleural blebs did not predict recurrence. Patients undergoing thoracoscopic blebectomy and mechanical pleurodesis at initial presentation had significantly lower recurrence rate compared to patients who underwent nonoperative management (operative group 14%, nonoperative group 45%; p = 0.0373).Conclusions
Recurrence following nonoperative management was high with the majority occurring within a year and requiring readmission. These findings support offering surgery to families as a potential initial management option.Level of Evidence
3b/4 — retrospective series or case control study, single institution, very limited population 相似文献19.
Yangyang R. Yu Carolyn M. Smith Kimberly K. Ceyanes Bindi J. Naik-Mathuria Sohail R. Shah Adam M. Vogel Kathleen E. Carberry Jed G. Nuchtern Monica E. Lopez 《Journal of pediatric surgery》2018,53(1):36-41
Purpose
Standardized clinical pathways for simple appendicitis decrease length of stay and result in cost savings. We performed a prospective cohort study to assess a same day discharge (SDD) protocol for children with simple appendicitis.Methods
All children undergoing laparoscopic appendectomy for simple appendicitis after protocol implementation (February 2016 to January 2017) were assessed. Length of stay (LOS), 30-day resource utilization (ED visits and hospital readmissions), patient satisfaction, and hospital accounting costs for SDD were compared to non-SDD patients.Results
Of 602 children treated at our institution, 185 (31%) were successfully discharged per protocol. SDD patients had longer median PACU duration (3.0 vs. 1.0 h, p < 0.001), but postoperative LOS (4.4 vs. 17.4 h, p < 0.001) and overall LOS (17.1 vs. 31.2 h, p < 0.001) were significantly shorter. Complication rates (1.6% vs. 3.1%), ED visits (4.3% vs. 6.0%), and readmissions (0.5% vs. 2.4%) were not significantly different for SDD compared to non-SDD patients. However, SDD decreases total cost of an appendectomy episode ($8073 vs $8424, p = 0.002), and patients report high satisfaction with their hospital experience (mean 9.4 out of 10).Conclusions
Safe and satisfactory outpatient management of pediatric simple appendicitis is achievable with appropriate patient selection. An SDD protocol can lead to significant generation of value to the healthcare system.Level of Evidence
Prognosis study, Level II. 相似文献20.