年龄作为重复手术和并发症的预测因素在手术管理的小儿科奇亚里形I型
Thomas Johnstone1, Maria Isabel Barros Guinle1, Laura M Prolo2
11Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and.
Journal of neurosurgery. Pediatrics
|September 20, 2024
概括
在3岁以上的儿童中推迟奇亚里形I型 (CM-I) 手术可能会减少重复手术和并发症风险. 接受CM-I减压的年幼儿童 (3岁及以下) 面临更高的不良事件率.
科学领域:
- 神经外科 神经外科
- 儿科手术 儿科手术
- 医学数据库 医学数据库
背景情况:
- 奇阿里形I型 (CM-I) 需要在症状出现时进行手术减压.
- 对CM-I的再开放率范围很大 (3-30%),表明需要更好的风险分层.
- 患者在初次手术时的年龄对重新手术和并发症风险的影响尚不清楚.
研究的目的:
- 为了研究患者在CM-I第一次手术减压时的年龄与随后的重新手术和并发症率之间的关联.
- 确定初始CM-I减压的最佳年龄门,以尽量减少不良结果.
主要方法:
- 利用MarketScan数据库 (2007-2021) 来分析患有CM-I手术减压的儿科患者 (0-21岁).
- 收集了有关患者人口统计,并发症,90天术后并发症和重复手术的数据.
- 采用多变量逻辑回归和二进制分类器来评估与年龄相关的风险并确定最佳的手术时间.
主要成果:
- 分析包括2675名患有并发症的患者和1157名重复手术的患者.
- 19.6%的人出现并发症,7.3%的人需要在90天内重新手术.
- 首次手术时的年龄增加独立预测了更低的重新手术 (OR 0.94) 和并发症 (OR 0.96) 率.
- 年龄为4岁被确定为最佳切线;患者>=4岁与<=3岁 (13.2%和27.7%,分别) 相比,重复手术 (5.5%) 和并发症 (18.4%) 率明显较低.
结论:
- 3岁及以下接受CM-I减压的儿科患者面临着重复手术和并发症的显著更高风险.
- 虽然紧急减压对于渐进性缺陷至关重要,但在医学上适当时,延迟手术超过3岁可能有利于减轻不良事件.
- 研究结果表明,年龄是预测CM-I手术减压后结果的关键因素.
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