دورية أكاديمية
أعرض في EDS

Perioperative outcomes in minimally-invasive versus open surgery in infants undergoing repair of congenital anomalies.

التفاصيل البيبلوغرافية
العنوان: Perioperative outcomes in minimally-invasive versus open surgery in infants undergoing repair of congenital anomalies.
المؤلفون: Gil LA; Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA., Asti L; Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA., Apfeld JC; Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA., Sebastião YV; Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Division of Global Women's Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA., Deans KJ; Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA., Minneci PC; Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA. Electronic address: Peter.Minneci@nationwidechildrens.org.
المصدر: Journal of pediatric surgery [J Pediatr Surg] 2022 Dec; Vol. 57 (12), pp. 755-762. Date of Electronic Publication: 2022 Aug 10.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Saunders Country of Publication: United States NLM ID: 0052631 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-5037 (Electronic) Linking ISSN: 00223468 NLM ISO Abbreviation: J Pediatr Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: Philadelphia, PA : Saunders
Original Publication: New York.
مواضيع طبية MeSH: Hernias, Diaphragmatic, Congenital*/surgery , Hirschsprung Disease* , Anorectal Malformations*, Humans ; Child ; Infant ; Reoperation ; Postoperative Period
مستخلص: Background: This study compared perioperative outcomes among infants undergoing repair of congenital anomalies using minimally invasive (MIS) versus open surgical approaches.
Methods: The ACS NSQIP Pediatric (2013-2018) was queried for patients undergoing repair of any of the following 9 congenital anomalies: congenital lung lesion (LL), mediastinal mass (MM), congenital malrotation (CM), anorectal malformation (ARM), Hirschsprung disease (HD), congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), hepatobiliary anomalies (HB), and intestinal atresia (IA). Inverse probability of treatment weights (IPTW) derived from propensity scores were utilized to estimate risk-adjusted association between surgical approach and 30-day outcomes.
Results: 12,871 patients undergoing congenital anomaly repair were included (10,343 open; 2528 MIS). After IPTW, MIS was associated with longer operative time (difference; 95% CI) (16 min; 9-23) and anesthesia time (13 min; 6-21), but less postoperative ventilation days (-1.0 days; -1.4- -0.6) and shorter postoperative length of stay (-1.4 days; -2.4- -0.3). MIS repairs had decreased risk of any surgical complication (risk difference: -6.6%; -9.2- -4.0), including hematologic complications (-7.3%; -8.9- -5.8). There was no significant difference in risk of complication when hematologic complications were excluded (RD -2.3% [-4.7%, 0.1%]). There were no significant differences in the risk of unplanned reoperation (0.4%; -1.5-2.2) or unplanned readmission (0.2%; -1.2-1.5).
Conclusions: MIS repair of congenital anomalies is associated with improved perioperative outcomes when compared to open. Additional studies are needed to compare long-term functional and disease-specific outcomes.
Mini-Abstract: In this propensity-weighted multi-institutional analysis of nine congenital anomalies, minimally invasive surgical repair was associated with improved 30-day outcomes when compared to open surgical repair.
Level of Evidence: III.
Competing Interests: Declaration of Competing Interest All authors declare they have no conflicts of interest or financial disclosures, including financial, consultant, institutional and other relationships that might lead to bias or a conflict of interest. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP provide the source of the data for this study and are not responsible for the statistical validity of the data analyses or conclusions drawn by the authors.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Congenital anomaly; Laparoscopy; Minimally invasive surgery; Neonatology; Surgical outcomes; Thoracoscopy
تواريخ الأحداث: Date Created: 20220819 Date Completed: 20221122 Latest Revision: 20221122
رمز التحديث: 20240628
DOI: 10.1016/j.jpedsurg.2022.08.002
PMID: 35985848
قاعدة البيانات: MEDLINE
الوصف
تدمد:1531-5037
DOI:10.1016/j.jpedsurg.2022.08.002