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1.
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2.
Objective
To compare treatment outcomes in children with Hirschsprung's disease who underwent treatment using the Duhamel or TERPT surgical procedures.Methods
Medline, Cochrane, EMBASE, and Google Scholar databases were searched through December 26, 2016. Search strings included Hirschsprung's disease, fecal incontinence, transanal endorectal pull-through, and Duhamel operation. Randomized controlled studies (RCTs) and retrospective studies that compared the treatment of Hirschsprung's disease in with TERPT or Duhamel surgical procedures in neonates, infants, or children were included.Results
The study included six studies with a total of 280 patients. The meta-analysis indicated that the Duhamel and TERPT interventions were similar with respect to rate of postoperative fecal incontinence (OR = 0.85, 95% CI = 0.37 to 1.92, P = 0.692) and operation time (difference in means = 46.68 min, 95% CI = ? 26.96 to 114.31, P = 0.226). The Duhamel procedure was associated with longer postoperative hospital stay (Difference in means = 3.14 days, 95% CI = 1.46 to 4.82, P < .001) and a lower rate of enterocolitis (OR = 0.21, 95% = 0.07 to 0.68, P = 0.009) compared with the TERPT procedure.Conclusions
The study found that Duhamel and TERPT procedures showed similar benefit in treating Hirschsprung's disease, although differences exist with respect to length of postoperative hospital stay and the incidence of enterocolitis.The type of study
Meta-analysis.Level of evidence
Level II. 相似文献3.
Suna Sun Weihua Pan Wenjie Wu Yiming Gong Jia Shi Jun Wang 《Journal of pediatric surgery》2018,53(8):1584-1587
Objectives
The treatment of long gap esophageal atresia (LGEA) is one of the most challenging congenital malformations in neonatal surgery. A preoperative bougienage stretching technique for elongation of the two segments of esophagus is applied to achieve utilizing the native esophagus to establish esophageal continuity by open or thoracoscopic approach.Methods
From January 2015 to May 2017, 12 neonates who suffered from LGEA were admitted to our department. They were divided into 2 groups (A and B) according to their admission time. They all accepted bougienage stretching technique before esophageal anastomosis.Results
Initially the lengths of esophageal gap in 12 infants ranged from 4 to 7.5 vertebral bodies (M = 5.8 ± 1.1). The gap lengths became –1 to 2.5 vertebral bodies after bougienage stretching technique and tension-free anastomosis were performed successfully for all 12 cases: Group A (n = 5) by thoracotomy and group B (n = 7) by thoracoscopic approach. 12 cases have been followed up for 1–25 months (M = 12.4 ± 8.5) after definitive surgery.Conclusions
Bougienage stretching technique for LGEA is feasible with satisfactory clinical results. Thoracoscopic approach is a good choice for primary anastomosis in LGEA.Levels of evidence
Treatment Study Level IV 相似文献4.
Introduction
The ability to use detailed, accurate current procedural terminology (CPT) codes is a key component of effective research. We examined the effectiveness of CPT codes to accurately reflect care in patients undergoing surgery for necrotizing enterocolitis (NEC).Methods
A multicenter retrospective analysis of operations on patients with NEC was conducted across 4 institutions between 2011 and 2016. Correlation between operative dictation and CPT coding was analyzed.Results
A total of 124 patients with NEC diagnosis undergoing exploratory abdominal operations were identified. NEC was improperly diagnosed in 25 patients, who were excluded from further analysis. Of the 99 patients reviewed, the initial exploratory abdominal operation was coded inaccurately in 58 cases (59%). Within these, 15 (26%) had multiple coding errors such that the nature of the original operation was not discernable from the applied codes. Inaccurate codes often did not describe the presence of a mucous fistula (n = 27, 44%), ostomy (n = 24, 39%), or extra segments of bowel resected (n = 9, 16%). The length of bowel resected is not currently described by any CPT codes.Conclusion
CPT coding for abdominal operations does not sufficiently reflect complexity of pediatric surgeries. This study highlights the significance of this inadequacy and its implications in future database studies in the era of electronic medical records.Level of evidence
Level IV.Type of study
Clinical research study. 相似文献5.
Muhammad Saleem Bilal Mirza Nabila Talat Muhammad Sharif 《Journal of pediatric surgery》2018,53(2):234-236
Background
Teratomas originating from the stomach are extremely rare and account for less than 1% of all cases of teratomas. This site of occurrence has unique diagnostic and management issues.Methods
A single centre case-record review of gastric teratomas presenting between January 2000 and April 2017 was performed.Results
Thirteen children were found to have gastric teratomas. Presenting features were abdominal distension in 12 (92%) and palpable abdominal mass in 9 (69%). At operation, 8 (61%) were exogastric tumors. The tumor was excised with partial gastrectomy (n = 7, 54%), total gastrectomy (n = 1, 8%), partial gastrectomy and limited transverse colectomy (n = 2, 15%), and excision of small part of serosa (mucosal sparing) (n = 3, 23%). Histopathologically, these were identified as mature gastric teratomas in 8 (61%). Three (23%) children died postoperatively.Conclusion
Gastric teratomas are rare, with the majority described as exogastric. Partial gastrectomy is always needed, but occasionally complete gastrectomy is necessary. Overall survival is > 75% in our experience.Level of evidence
IV 相似文献6.
Luciano A. Favorito Kleber M. Anderson Suelen F. Costa Waldemar S. Costa Francisco JB Sampaio 《Journal of pediatric surgery》2018,53(4):780-783
Objective
To analyze the structure of the cremaster in patients with retractile testis (RT), comparing the distribution of nerves, elastic system and muscles with patients having cryptorchidism and inguinal hernia (IH).Patients and methods
We studied 31 patients, 17 with RT (mean age = 5.17years); 9 with IH (mean age = 2.6) and 5 with cryptorchidism (mean age = 3). A cremaster biopsy was performed and submitted to routine histological processing and studied using histochemistry and immunohistochemistry. The samples were photographed under an Olympus BX51 microscope. The images were processed with the Image J software and the cremaster muscle structures were quantified. Means were compared statistically using ANOVA and the unpaired t-test (p < 0.05).Results
There were no differences (p = 0.08) in diameter of muscle fiber between the groups. The muscle fiber density differed between patients with RT and IH (p = 0.02): RT (mean = 17.71%, SD = 16.67), IH (mean = 38.06%, SD = 14) and cryptorchidism (mean = 21.47%, SD = 16.18). There was no difference (p = 0.07) in the density of elastic fibers in the three groups. We observed a lower concentration of cremaster nerves of patients with RT compared with IH (p = 0.0362): RT (mean = 1.72%, SD = 0.58), IH (mean = 3.28% SD = 0.94) and cryptorchidism (mean = 2.52%, SD = 0.53).Conclusions
Retractile testis is not a normal variant, and presented a similar cremaster muscle structure as in patients with cryptorchidism.Level of evidence
II; prospective comparative study. 相似文献7.
Abdullah Alshehri Kourosh Afshar Julie Bedford Graeme Hintz Erik D Skarsgard 《Journal of pediatric surgery》2018,53(5):1046-1051
Introduction
Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <?2) and obesity (BMI Z-scores > + 2) with 30-day postoperative outcomes.Methods
We queried the Pediatric NSQIP Participant Use File and extracted data on patients’ age 29 days to 18 years who underwent abdominal or thoracic procedures. Normalized anthropometric measures were calculated, including weight-for-height for < 2 years, BMI for ages ≥ 2 years, and height for age. Logistic regression models were developed to assess nutritional outlier status as an independent predictor of postoperative outcome.Results
23,714 children (88% ≥ 2y) were evaluated. 4272 (18%) were obese, while 2640 (11.1%) and 904 (3.8%) were stunted and wasted, respectively, after controlling for gender, ASA/procedure/wound classification, preoperative steroid use, need for preoperative nutritional support, and obese children had higher odds of SSIs (OR 1.29, 95% CI 1.1–1.5, p = 0.001), while stunted children were at increased risk of any 30-day postoperative complication (OR 1.16, 95% CI 1.0–1.3, p = 0.036).Conclusion
Children who are stunted or obese are at increased risk of adverse outcome after abdominal or thoracic surgery.Level of Evidence
III 相似文献8.
James K. Wall Tiffany J. Sinclair William Kethman Christina Williams Craig Albanese Karl G. Sylvester Matias Bruzoni 《Journal of pediatric surgery》2018,53(3):503-507
Background
Minimal access surgery (MAS) has gained popularity in infants less than 5 kg, however, significant challenges still arise in very low weight infants.Study design
A retrospective chart review was performed to identify all infants weighing less than 3 kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts.Results
A total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p = 0.003). There were no deaths within 30 days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort.Conclusion
Advanced MAS may be performed in infants weighing less than 3 kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures.Type of study
Prognosis study.Level of evidence
Level III. 相似文献9.
Khalid Alzahrani Julien Lejeune Walid Lakhal Baptiste Morel Ann-Rose Cook Karim Braïk Hubert Lardy Aurelien Binet 《Journal of pediatric surgery》2018,53(7):1417-1419
Background
Port-a-cath (PAC) is an essential device in the management of the patients of chronic illness, but despite theirs benefits there are many complications either at the time of insertion or at time of removal. Our aim of this study is to evaluate the fracture rate of the catheter at removal time in comparison with catheter type either polyurethane or silicone.Methods
A retrospective monocentric study of all PACs which were removed at our university pediatric hospital between 1 January 2006 and 31 December 2016. Two groups were compared: polyurethane group and silicone group.Results
Total of 216 central lines were removed, the mean age at the time of extraction was 9.7 ± 4.9 years and the mean time for both catheter was 2.7 ± 1.6 years, fracture occurred in 11 catheter of the polyurethane group (n = 119), with no fracture of silicone group (n = 86), in the polyurethane group, the risk of catheter fracture is significantly related to the duration of the PAC in place.Conclusion
We found that the polyurethane-based catheters are more vulnerable for rupture and retained fragment in the blood vessels, especially if left in place for long time, for this reason we have switched to silicone-based catheter and all catheters should be remove within duration maximal of 2 years.Type of study
Prognosis study.Level of evidence
Level II. 相似文献10.
Keisuke Suzuki Makoto Komura Kan Terawaki Tetsuro Kodaka Takumi Gohara Hiroko Komura Yasuhide Nakayama 《Journal of pediatric surgery》2018,53(2):330-334
Background
Prosthetic patches can be used to repair large congenital diaphragmatic hernia defects but may be associated with infection, recurrence, and thoracic deformity. Biosheets (collagenous connective tissue membranes) have been used in regenerative medicine. We evaluated the efficacy of Biosheets in a rabbit model.Methods
Biosheets were prepared by embedding silicone plates in dorsal subcutaneous pouches of rabbits for 4 weeks. In group 1 (n = 11), Gore-Tex® sheets (1.8 × 1.8 cm) were implanted into a diaphragmatic defect. In group 2 (n = 11), Seamdura®, a bioabsorbable artificial dural substitute, was implanted in the same manner. In group 3 (n = 14), biosheets were autologously transplanted into the diaphragmatic defects. All rabbits were euthanized 3 months after transplantation to evaluate their graft status.Results
Herniation of liver was observed in 5 rabbits (45%) in group 1, 8 (73%) in group 2, and 3 (21%) in group 3. A significant difference was noted between groups 2 and 3 (P = 0.017). Biosheets had equivalent burst strength and modulus of elasticity as native diaphragm. Muscular tissue regeneration in transplanted biosheets in group 3 was confirmed histologically.Conclusion
Biosheets may be applied to diaphragmatic repair and replacement of diaphragmatic muscular tissue.Level of evidence
Level III. 相似文献11.
David I. Chu Jonathan M. Tan Peter Mattei Allan F. Simpao Andrew T. Costarino Aseem R. Shukla Joseph W. Rossano Gregory E. Tasian 《Journal of pediatric surgery》2018,53(10):1980-1988
Background
Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.Methods
We performed a retrospective cohort study using the 2013–2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children < 18 years old who underwent laparoscopic surgery to 45,012 children who underwent open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay.Results
Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15–0.79]), inhospital mortality (OR 0.42 [0.22–0.81]) and 30-day morbidity (OR 0.61 [0.50–0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend = 0.01) and in-hospital mortality (ptrend = 0.05), but not for 30-day mortality (ptrend = 0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children.Conclusions
Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD.Level-of-evidence
Level III: Treatment Study. 相似文献12.
Tiffany J. Zens Andrew P. Rogers Erica L. Riedesel Charles M. Leys Daniel J. Ostlie Michael A. Woods Kara G. Gill 《Journal of pediatric surgery》2018,53(6):1168-1174
Introduction
Contrast-enhanced CT remains the first-line imaging for evaluating postoperative abscess (POA) after appendicitis. Given concerns of ionizing radiation use in children, we began utilizing quick MRI to evaluate POA and summarize our findings in this study.Materials and Methods
Children imaged with quick MRI from 2015 to 2017 were compared to children evaluated with CT from 2012 to 2014 using an age and weight matched case–control model. Radiation exposure, size and number of abscesses, length of exam, drain placement, and patient outcomes were compared.Results
There was no difference in age or weight (p > 0.60) between children evaluated with quick MRI (n = 16) and CT (n = 16). Mean imaging time was longer (18.2 ± 8.5 min) for MRI (p < 0.001), but there was no difference in time from imaging order to drain placement (p = 0.969). No children required sedation or had non-diagnostic imaging. There were no differences in abscess volume (p = 0.346) or drain placement (p = 0.332). Thirty-day follow-up showed no difference in readmissions (p = 0.551) and no missed abscesses. Quick MRI reduced imaging charges to $1871 from $5650 with CT.Conclusion
Quick MRI demonstrated equivalent outcomes to CT in terms of POA detection, drain placement, and 30-day complications suggesting that MRI provides an equally effective, less expensive, and non-radiation modality for the identification of POA.Type of Study
Retrospective Case–Control Study.Level of Evidence
Level III. 相似文献13.
Aim
The purpose of this study was to report surgical management and outcome of corrosive-induced gastric injuries in children at our institute over the last decade.Patients & method
Medical records of patients admitted for corrosive-induced gastric injury at the Pediatric Surgery Department of Ain Shams University between January 2007 and January 2017 were retrospectively reviewed.Results
Twenty six cases (17 boys and 9 girls) were enrolled. Mean age was 3.61 ± 1.29. Ingested agent was acid in all the patients. Main presenting symptom was gastric output obstruction in 22 cases. The interval between corrosive ingestion and presentation ranged from one to 135 days (mean = 43.9 ± 34). Surgical procedure included total gastrectomy (n = 2), partial gastrectomy (n = 2), augmentation gastroplasty (n = 1), Billroth I (n = 2), antrectomy (n = 2), antroplasty (n = 3), gastrojejunostomy (n = 2), Heineke–Mikulicz pyloroplasty (n = 9), Finney pyloroplasty (n = 5), and feeding jejunostomy (n = 4). Anastomotic stricture requiring a second operation developed in one patient. There were three mortalities related to the associated esophageal strictures. The mean follow-up period is 3.5 years. All patients are free of symptoms and gained adequate weight.Conclusion
Surgery is the mainstay of management for corrosive-induced gastric injuries with good long-term results. Surgical procedure should be tailored according to the patient's general condition and extent of gastric injury.Level of evidence
This is a case series with no comparison group (level IV). 相似文献14.
Lucia Ortega-Laureano Teresa Santiago Gabriela Maron Andrew M. Davidoff Israel Fernandez-Pineda 《Journal of pediatric surgery》2018,53(6):1129-1133
Background/Purpose
Pulmonary complications are some of the leading causes of morbidity and mortality in immunocompromised pediatric patients. We sought to assess the value of surgical lung biopsy (SLB) in hematopoietic cell transplantation (HCT) pediatric patients.Methods
A retrospective review of patients who underwent SLB within one year of HCT between 1999 and 2015 was performed.Results
Twenty-nine patients (15 females, 14 males) with a median age of 10 years (range, 0.6–23) were identified. Median interval between HCT and SLB was 114.8 days (range, 16–302). At surgery, 11 (38%) patients were intubated, and 7 (24%) were receiving supplemental oxygen. The most common histological finding was cryptogenic organizing pneumonia in 8 cases (27%), followed by infection in 7 (24%). Perioperative complications (17%) included bronchopleural fistula (n = 2), splenic laceration from a trocar injury (n = 2), and hemothorax (n = 1). Changes in therapy occurred in 25 patients (86%). Twenty-four (83%) patients survived more than 30 days post SLB, and the overall survival rate was 41% with a median follow-up of 8.5 years (range, 1–13).Conclusion
SLB appears to be safe and informative in pediatric patients after HCT and led to changes in therapy in most patients. However, long-term survival after this procedure was < 50%, reinforcing the fact that pulmonary complications are some of the leading causes of mortality in these patients.Type of Study
Retrospective analysis.Level of Evidence
Level IV. 相似文献15.
Nick Lansdale Nadeem Al-Khafaji Patrick Green Simon E Kenny 《Journal of pediatric surgery》2018,53(3):540-544
Objectives
Determine national outcomes for pyloromyotomy; how these are affected by: (i) surgical approach (open/laparoscopic), or (ii) centre type/volume and establish potential benchmarks of quality.Methods
Hospital Episode Statistics data were analysed for admissions 2002–2011. Data presented as median (IQR).Results
9686 infants underwent pyloromyotomy (83% male). Surgery was performed in 22 specialist (SpCen) and 39 nonspecialist centres (NonSpCen). The proportion treated in SpCen increased linearly by 0.4%/year (r = 0.76, p = 0.01). Annual case volume in SpCen vs. NonSpCen was 40 (24–53) vs. 1 (0–3). Time to surgery was shorter in SpCen (1 day [1, 2] vs. 2 [1–3]), but total stay equal (4 days [3–6]). 137 (1.4%) had complications requiring reoperation (wound problem 0.6%; repeat pyloromyotomy 0.5% and perforation, bleeding or obstruction 0.2%): pooled rates were similar between SpCen and NonSpCen (1.4% vs. 1.6%, p = 0.52). Three NonSpCen had > 5% reoperations (within 99.8% C.I. as small denominators). There was no relationship between reoperation and centre volume. Laparoscopic pyloromyotomy had increased risk of repeat pyloromyotomy (OR 2.28 [1.14–4.57], p = 0.029).Conclusions
Pyloric stenosis surgery shifted from centres local to patients, but outcomes were unaffected by centre type/volume. Modest reported benefits of laparoscopy appear offset by increased reoperations. Quality benchmarks could be set for reoperation < 4%.Type of study
Treatment Study.Level of evidence
Level III. 相似文献16.
Joana Barbosa Sequeira Ana Coelho Ana Sofia Marinho Berta Bonet Fátima Carvalho João Moreira-Pinto 《Journal of pediatric surgery》2018,53(10):2003-2007
Purpose
To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes.Methods
A retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed. Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups.Results
We analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics. Operative time was similar for both groups (30 vs. 38 min; p > 0.05). No major intraoperative complications were reported. Wound infection rate was lower for EPSiT ((5.2% [n = 1] vs. 20.0% [n = 12]); p > 0.05). Healing time was similar for both groups (28 vs. 37.5 days). Recurrence occurred in 18,9% (n = 15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC. There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p > 0.05).Conclusions
Our results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population.Level of evidence
Therapeutic study – level III. 相似文献17.
Silvia Yukari Togoro Miguel Lia Tedde Robert S Eisinger Erica Mie Okumura Jose Ribas Milanez de Campos Paulo Manuel Pêgo-Fernandes 《Journal of pediatric surgery》2018,53(3):406-410
Background
To minimize cardiac perforation during the minimally invasive repair of pectus excavatum (MIRPE), several surgeons have suggested using a suction device to intraoperatively lift the sternum. Whether or not this technique is effective for all PE patients is not yet known. As such, our aim was to quantify the extent to which a suction device is capable of lifting the sternum with a short duration of use.Methods
30 PE patients received a low-dose CT scan as part of standard PE evaluation. A Vacuum Bell suction was then applied for only two minutes, and a repeat CT scan was obtained only at the deepest point of the chest wall deformity. We compared chest dimensions before and after Vacuum Bell suction.Results
The Vacuum Bell lifted the sternum in all 29 patients included in the analysis. The absolute change in depth ranged from 0.29 to 23.67 mm (M = 11.02, SD = 6.05). The average improvement in Haller index was 0.76. The suction was most effective for individuals with low BMI and smaller chest depths. Efficacy was not associated with gender, age, or chest morphology.Conclusions
The Vacuum Bell device effectively lifted the sternum in PE patients with different demographics and chest morphologies. Future research is needed to address whether or not the device reduces risk of cardiac perforation during MIRPE.Levels of evidence
Prognosis Study Level IV. 相似文献18.
Ferdynand Hebal Hayley T. Sparks Karen L. Rychlik Meredith Bone Sifrance Tran Katherine A. Barsness 《Journal of pediatric surgery》2018,53(4):794-797
Background/purpose
Arterial catheter complications are a common problem in a pediatric critical care setting, but reported complication rates and risk factors associated with peripheral arterial catheter complications vary. We conducted a retrospective cohort study to identify risk factors in a pediatric patient population.Methods
We performed a detailed abstraction of provider notes in the electronic medical records of inpatients ≤ 18 years of age who underwent arterial line placement between January 1, 2008 and January 1, 2013 at a university-affiliated standalone pediatric hospital. Inpatient records were assessed for complications associated with arterial catheterization and risk factors inherent to arterial catheter insertion.Results
Two hundred twenty-eight children were identified, of whom 75 (33%) had a total of 106 arterial catheter complications. Complications included line malfunctions (59%, n = 63), bleeding (16%, n = 17), multiple complications (11%, n = 12), infiltration (8%, n = 9), and hematoma (4%, n = 4). Line malfunction was reported in all patients with multiple complications. Independent predictors of complications associated with arterial catheterization were the presence of more than one provider during the insertion (p = 0.007) and insertion attempts at multiple sites (p = 0.036).Conclusions
Our analysis suggests the need for a prospective study to comprehensively assess provider-related risk factors associated with arterial catheter complications in children.Level of evidence
IV 相似文献19.
Lofty-John Anyanwu Aminu Mohammad Lawal Abdullahi Aliyu Farinyaro Stephen Obaro 《Journal of pediatric surgery》2018,53(4):847-852
Background
Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality.Methods
We retrospectively reviewed the records of all children presenting to our unit with typhoid intestinal perforation (TIP) between March 2009 and December 2013. The patients were grouped based on postoperative outcome status and were compared with respect to patient related variables, using chi square test. Multivariate analysis was performed using a binary logistic regression model. Significance was assigned to a p-value < 0.05.Results
The records of 129 children were analyzed. There were 78 (60.5%) boys and 51 (39.5%) girls. The male/female ratio was 1.53:1. Their ages ranged from 3 years to 13 years (mean 8.14 years; SD 2.61 years). A single intestinal perforation was seen in 73.4% (94/128) of them, while 26.6% (34/128) had two or more. Mortality rate was 10.9%. Multivariate analysis showed that multiple intestinal perforations significantly predicted postoperative mortality (p = 0.005) and development of postoperative fecal fistula (p = 0.013), while serum albumin < 32 g/L was a predictor of postoperative surgical site infection (p = 0.002).Conclusion
Multiple intestinal perforations, a postoperative fecal fistula and hypoalbuminemia adversely affected outcome in our patients.Level of evidence
III (Retrospective study). Type of study—Prognosis study. 相似文献20.
Inna N. Lobeck Amir M. Alhajjat Phylicia Dupree John M. Racadio Mark M. Mitsnefes Rebekah Karns Greg M. Tiao Jaimie D. Nathan 《Journal of pediatric surgery》2018,53(9):1825-1831