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1.
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2.
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3.
Background
In congenital undescended testis (UDT) in humans, thermal insult damages early germ cell development during mini-puberty (3–6 months) causing increased risk of both cancer and infertility. In rodents however, UDT causes infertility but not cancer. In the TS rat with congenital UDT we hypothesized that early germ cell development would be normal as UDT only becomes manifest at 3–4 weeks (and the germ cells only become sensitive to thermal injury) after minipuberty is complete at 1 week.Methods
Normal testis and potential UDT from unilateral cryptorchid TS rats were collected at week 1 and 4 and processed into paraffin sections labeled for Sertoli cells (AMH), early germ cells (MVH) and spermatogonial stem cells (PLZF). Confocal microscopic images and Fiji Image J were used to count cells in testicular tubules with paired T-test statistical analysis.Results
Total germ cells/tubule, basement membrane-bound germ cells/tubule, and Sertoli cells/tubule were unchanged between normally descending and future UDT at 1–4 weeks old (P > 0.05) Total germ cells/tubule and spermatogonial stem cells/tubule increased dramatically between weeks 1 and 4.Conclusion
Rat gonocyte transformation is normal in both normally descending and future UDT. This suggests that congenitally cryptorchid rats may not develop testicular cancer because gonocytes (the putative origin of malignant degeneration) normally transform into spermatogonial stem cells before UDT occurs and the risk of thermal injury develops. This suggests the TS rat may be a good model for acquired UDT in human where the abnormal testicular position develops after gonocyte transformation is completed in the first year. 相似文献4.
Cory McLaughlin Jessica A. Zagory Michael Fenlon Caron Park Christianne J Lane Daniella Meeker Randall S. Burd Henri R. Ford Jeffrey S. Upperman Aaron R. Jensen 《Journal of pediatric surgery》2018,53(2):344-351
Background/purpose
The classic “trimodal” distribution of death has been described in adult patients, but the timing of mortality in injured children is not well understood. The purpose of this study was to define the temporal distribution of mortality in pediatric trauma patients.Methods
A retrospective cohort of patients with mortality from the National Trauma Data Bank (2007–2014) was analyzed. Categorical comparison of ‘dead on arrival’, ‘death in the emergency department’, and early (≤ 24 h) or late (> 24 h) inpatient death was performed. Secondary analyses included mortality by pediatric age, predictors of early mortality, and late complication rates.Results
Children (N = 5463 deaths) had earlier temporal distribution of death compared to adults (n = 104,225 deaths), with 51% of children dead on arrival or in ED compared to 44% of adults (p < 0.001). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 d and 0.8 days versus 1.6 days, p < 0.001). Older age, penetrating mechanism, bradycardia, hypotension, tube thoracostomy, and thoracotomy were associated with early mortality in children.Conclusions
Injured children have higher incidence of early mortality compared to adults. This suggests that injury prevention efforts and strategies for improving early resuscitation have potential to improve mortality after pediatric injury.Level of evidence
Level III: Retrospective cohort study. 相似文献5.
Sergio A. Acuna Winnie Lam Corinne Daly S. Joseph Kim Nancy N. Baxter 《Transplantation reviews (Orlando, Fla.)》2018,32(1):29-35
Background
Active malignancies are a contraindication to transplantation, as immunosuppression can lead to worse cancer outcomes; therefore, ensuring transplant candidates are free of malignancy before transplantation is essential. This systematic review assesses the availability, quality, and consistency of recommended cancer evaluation prior to transplantation in Clinical Practice Guidelines (CPGs) for the selection of solid organ transplant candidates.Methods
We systematically searched for CPGs for the assessment of transplant candidates. The characteristics of included CPGs, strength of recommendations and supporting evidence were extracted. A quality assessment of the CPGs was conducted using the AGREE II tool.Results
We identified 52 CPG for the selection of solid organ transplant candidates. Only 13 (25%) included recommendations for cancer evaluation as part of the assessment of transplant candidates. Most recommended age and sex appropriate cancer screening as per the general population guidelines. Recommendations to evaluate for other malignancies and for high-risk candidates were variable. Most recommendations were based on expert opinion and only two CPGs provided an explicit link between the recommendations and supporting evidence.Conclusion
There is a lack of clear and consistent recommendations for pretransplant cancer evaluation in existing CPGs. Although there is some consensus regarding the indication to screen for cancer as per the recommendations for the general population, these recommendations are not an appropriate risk reduction strategy for transplant candidates. Standardized protocols to ensure transplant candidates are cancer free prior to transplantation are needed. 相似文献6.
Heather L. Short Natalie Taylor Mitali Thakore Kaitlin Piper Katherine Baxter Kurt F. Heiss Mehul V. Raval 《Journal of pediatric surgery》2018,53(3):418-430
Purpose
Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve outcomes in adult abdominal surgical populations. Our purpose was to survey pediatric surgeons' opinions regarding applicability of individual ERAS elements to children's surgery.Methods
A survey of the American Pediatric Surgical Association was conducted electronically. Using a 5-point Likert scale, respondents rated their willingness to implement 21 adult ERAS elements in an adolescent undergoing elective colorectal surgery.Results
Of an estimated 1052 members, 257 completed the survey (24%). The majority of the respondents (n = 175, 68.4%) rated their familiarity with ERAS as “moderately”, “very”, or “extremely familiar”. However only 19.2% (n = 49) replied that they were “already implementing” an ERAS protocol in their practice. Most respondents replied that they were “already doing” or “definitely willing” to implement 14 of the 21 (67%) ERAS elements. For the remaining 7 elements, > 10% of surgeons answered that they were only “somewhat willing” to, “uncertain” about or “unwilling” to implement these interventions.Conclusions
Most respondents were willing to implement the majority of adult ERAS concepts in children undergoing abdominal surgery. However, we identified 7 elements that remain contentious. Further investigation regarding the safety and feasibility of these elements is warranted before applying them to children's surgery.Level of evidence
Level V. 相似文献7.
Shireen Anne Nah Caroline C.P. Ong Seyed Ehsan Saffari Lin Yin Ong Te-Lu Yap Yee Low Anette S. Jacobsen 《Journal of pediatric surgery》2018,53(8):1550-1554
Background
Patients with anorectal malformation (ARM) and Hirschsprung’s disease (HD) face long-term disturbance in bowel function even after definitive surgery. This study evaluates the quality of life (QOL) of patients with ARM and HD, and compares them to healthy controls using self-report questionnaires.Methodology
A prospective study was performed recruiting patients with ARM or HD from September 2013 to December 2014 who had primary surgery done in our institution at least 2 years prior to participation. Age-matched and gender-matched controls were enrolled from our patients with minor outpatient complaints. All participants completed the following PedsQL? scales (maximum score 100): 4.0 Generic Core Scales, 3.0 General Well-Being (GWB) Scale and 2.0 Family Impact (FI) Module. All were also scored on bowel function (BFS), with a maximum score 20. Appropriate statistical analysis was performed, with significance level < 0.05.Results
There were 193 participants: 87 controls, 62 ARM, 44 HD. When comparing Core, GWB and FI scores, there were no significant differences between groups although controls had best scores indicating best QOL and general wellbeing, with least impact of the child’s health on the family. BFS was significantly different with controls having best and ARM worst scores. There were no significant differences in scores between parent and child indicating intradyad consistency. There was significant positive correlation between BFS and Core (p < 0.0001), and between BFS and GWB scores (p < 0.005); and significant negative correlation between BFS and FI scores (p < 0.0001).Conclusions
Bowel function impacts quality of life. Those with ARM and HD can achieve good quality of life comparable to controls, based on patient and caregiver self-reported outcomes.Type of study
Prospective comparative studyLevel of evidence
Level II. 相似文献8.
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.
11.
12.
Punam P. Parikh Jun Tashiro Gustavo A. Rubio Juan E. Sola Holly L. Neville Anthony R. Hogan Eduardo A. Perez 《Journal of pediatric surgery》2018,53(9):1753-1760
Background
There is a paucity of literature on treatment of melanoma in children with surgical management extrapolated from adult experience. The incidence and clinical outcomes of pediatric extremity melanoma were studied.Methods
SEER registry was analyzed between 1973 and 2010 for patients < 20 years old with extremity melanoma. Multivariate and propensity-score matched analyses were performed to identify independent predictors of survival.Results
Overall, 917 patients were identified with an age-adjusted incidence of 0.2/100,000 persons, annual percent change 0.96. Most had localized disease (77%), histology revealing melanoma-not otherwise specified (52%). Surgical procedures performed included wide local excision (50%), excisional biopsy (32%), lymphadenectomy (LA) (28%), and sentinel lymph node biopsy (SLNB) (15%). Overall, 30-year disease specific mortality was 7% with lower survival for extremity melanoma (90%), males (89%), nodular histology (69%), and distant disease (36%) (all P < 0.05). Post-treatment multivariate analysis revealed localized disease (HR 9.76; P = 0.006) as an independent prognosticator of survival; earlier diagnostic years 1988–1999 (HR 2.606; P = 0.017) were a negative prognosticator of survival. Propensity-score matched analysis found no difference in survival between SLNB/LA vs no sampling for regional/distant disease.Conclusions
Pediatric extremity melanoma in SEER demonstrate no survival advantage between children undergoing sampling procedures vs no sampling for regional/distant disease.Type of study
Retrospective, prognostic study.Level of evidence
III. 相似文献13.
Katerina Dukleska Loren Berman Allison A. Aka Charles D. Vinocur Erin A. Teeple 《Journal of pediatric surgery》2018,53(6):1154-1159
Introduction
Patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) commonly undergo restorative proctocolectomy with ileal-pouch anal anastomosis (RP-IPAA). We sought to describe patient characteristics and postoperative outcomes in this patient population.Methods
Using the National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who were 6–18 years old who underwent RP-IPAA for FAP or UC were identified. Postoperative morbidity, including reoperation and readmission were quantified. Associations between preoperative characteristics and postoperative outcomes were analyzed.Results
A total of 260 children met the inclusion criteria, of which 56.2% had UC. Most cases were performed laparoscopically (58.1%), and the operative time was longer with a laparoscopic versus open approach (326 [257–408] versus 281 [216–391] minutes, p = 0.02). The overall morbidity was 11.5%, and there were high reoperation and readmission rates (12.7% and 21.5%, respectively). On bivariate analysis, preoperative steroid use was associated with reoperation (22.5% versus 10.9%, p = 0.04). On multivariable regression analysis, obesity was independently associated with reoperation (odds ratio: 3.34 [95% confidence intervals: 1.08–10.38], p = 0.04).Conclusions
Children who undergo RP-IPAA have high rates of overall morbidity, reoperation, and readmission. Obesity was independently associated with reoperation. This data can be used by practitioners in the preoperative setting to better counsel families and establish expectations for the postoperative setting.Type of Study
Retrospective Comparative Study.Level of Evidence
Level III. 相似文献14.
Punam P. Parikh Eduardo A. Perez Holly L. Neville Anthony R. Hogan Juan E. Sola 《Journal of pediatric surgery》2018,53(6):1175-1180
Introduction
There remains a paucity of literature on survival related to pediatric appendiceal tumors. The purpose of this study was to determine the incidence, surgical management, and survival outcomes of appendiceal tumors in pediatric patients.Methods
The Surveillance, Epidemiology, and End Results (SEER) Registry was analyzed for pediatric appendiceal tumors from 1973 to 2011. Parameters analyzed were: tumor type, surgical management (appendectomy vs. extensive resection), tumor size, and lymph node sampling. Chi-square analysis for categorical and Student's t test for continuous data were used.Results
Overall, 209 patients had an appendiceal tumor, including carcinoid (72%), appendiceal adenocarcinoma (16%), and lymphoma (12%). Patients undergoing appendectomy vs. extensive resection had similar 15-year survival rates (98% vs. 97%; p = 0.875). Appendectomy vs. extensive resection conferred no 15-year survival advantage when patients were stratified by tumor type, including adenocarcinoma (87% vs. 89%; p = 0.791), carcinoid (100% vs. 100%; p = 0.863), and lymphoma (94% vs. 100%; p = 0.639). There was no significant difference in 15-year survival between tumor size groups ≥ 2 and < 2 cm (both 100%) and presence or absence of lymph node sampling (96% and 97%; p = 0.833) for all patients with a carcinoid tumor.Conclusion
Appendectomy may be adequate for pediatric appendiceal tumors. Extensive resection may be of limited utility for optimizing patient survival, placing patient at greater operative risk.Type of Study
Retrospective Prognostic Study.Level of Evidence
III 相似文献15.
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16.
Ihab Halaweish Jane Riebe-Rodgers Amy Randall Peter F Ehrlich 《Journal of pediatric surgery》2018,53(4):748-751
Introduction
Recently, two large prospective clinical trials developed and validated prediction rules for children at very low risk for clinically important traumatic brain injuries (ciTBI) or abdominal injury for whom CT is unnecessary. Specific criteria/guidelines were identified which if met would obviate the need for CT scanning. The purpose of this study was to assess compliance at a level one pediatric center with these guidelines as a tool for quality improvement.Methods
Records of children admitted to our pediatric trauma center one year before and two years after publication of head (Kuppermann ’09) and abdominal trauma (Holmes ’13) CT imaging guidelines were reviewed. Data collected included demographics, Glasgow coma score, (GCS), injury severity score (ISS), mechanism of injury, and indication for imaging based on criteria/guidelines from the prediction rule including history, symptoms, and physical exam findings.Results
There were 296 total patients identified. Demographic data, GCS, ISS, and mechanism of injury were similar between both groups before and after guideline publication. Prior to publication of head trauma imaging guidelines, 20.7% of head trauma patients had no indication for head CT prior compared with 19.5% after publication of imaging guideline (p = 0.85). Prior to publication of abdominal trauma imaging guidelines, 28.9% of patients had no indication for abdominal CT compared with 31.5% after publication of imaging guidelines (0.76). The rate of ciTBI requiring intervention was 4.6% before and 1.1% after guideline publication (p = 0.4). The rate of abdominal injury requiring intervention was 7.9% before and 1.8% post guideline publication (p = 0.2). None of the children at very low risk for ciTBI or abdominal injury required surgical intervention.Conclusion
At our institution compliance with evidence-based guidelines for CT of children with head and abdominal trauma is poor with a significant number of patients undergoing unnecessary imaging. This provides an opportunity for quality improvement with evidence based methods to reduce unnecessary imaging for trauma.Level of evidence
IIIType of study
Clinical Research Paper 相似文献17.
Emma C. Hamilton Julius Balogh Duc T. Nguyen Edward A. Graviss Andras A. Heczey Mary T. Austin 《Journal of pediatric surgery》2018,53(1):163-168
Background/purpose
The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies.Methods
The United Network for Organ Sharing (UNOS) database was queried for all patients < 18 years old who received an OLT with a primary malignant liver tumor between 1987 and 2012 (n = 544). Five-year patient and graft survival were determined using Kaplan–Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model.Results
The majority of patients were diagnosed with hepatoblastoma (HB) (n = 376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant.Conclusions
In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types.Type of study
Case series with no comparison group.Level of evidence
IV. 相似文献18.
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19.
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20.
Andrew Nordin Alan Coleman Junxin Shi Krista Wheeler Henry Xiang Shannon Acker Denis Bensard Brian Kenney 《Journal of pediatric surgery》2018,53(1):130-135