Frequency of Potentially Avoidable Surgical Referrals for Asymptomatic Umbilical Hernias in Children.
Frequency of Potentially Avoidable Surgical Referrals for Asymptomatic Umbilical Hernias in Children.
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DOI：
10.1016/j.jss.2022.04.022
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发表时间：
2022-09
影响因子：
2.2
通讯作者：
Rangel, Shawn J.
中科院分区：
文献类型：
--
作者：
He, Katherine;Hills-Dunlap, Jonathan L.;Kashtan, Mark A.;Riley, Heather;Henry, Owen S.;Graham, Dionne A.;Wynne, Nicole;Cramm, Shannon L.;Rangel, Shawn J.
关键词：
美国儿科协会于2019年发布了指南，建议将无症状脐疝儿童的手术转诊延迟至4-5岁。本研究的目的是评估该队列儿童中当前可能避免的转诊率，并评估指南发布后转诊率是否有所下降。回顾性分析了2014年10月至2021年8月在一家儿科外科诊所评价的脐疝转诊情况。潜在可避免的转诊（PAR）定义为无嵌顿史的3岁或3岁以下儿童无症状、非扩大性脐疝转诊。比较指南发布前后的转诊指征、门诊访视后的分布和PAR发生率。共评估了803例脐疝转诊病例，其中48%在评估时为3岁或3岁以下的儿童（“早期”转诊）。33%的所有转诊和68%的早期转诊被归类为PAR，指南发布前后的比率相似（所有转诊：32% vs 33%，P = 0.94;早期转诊：68% vs 67%，P = 0.94）。在333例早期转诊患者中，有2例（0.6%）发生嵌顿，通过成功复位和间隔修复进行了治疗。所有转诊进行脐疝评估的病例中有三分之一是可以避免的，并且在美国儿科学会指南发布后，这一比例没有改变。通过改进教育和指南传播，使外科医生和转诊提供者之间的期望保持一致，可能会减少可避免的就诊，降低护理人员的生产力，并减少可能避免的手术。
The American Association of Pediatrics released guidelines in 2019 recommending delay of surgical referral in children with asymptomatic umbilical hernias until 4-5 y of age. The purpose of this study was to assess contemporary rates of potentially avoidable referrals in this cohort of children, and to assess whether rates have decreased following guideline release. Retrospective analysis of umbilical hernias referrals evaluated at a single pediatric surgery clinic from October 2014 to August 2021. Potentially avoidable referrals (PAR) were defined as asymptomatic, non-enlarging umbilical hernia referrals in a child 3 y of age or younger without a history of incarceration. Referral indication, disposition following clinic visit, and rates of PAR were compared before and after guideline release. A total of 803 umbilical hernia referrals were evaluated, of which 48% were in children 3 y of age or younger at time of evaluation (“early” referrals). 33% of all referrals and 68% of early referrals were categorized as a PAR, and rates were similar before and after guideline release (all referrals: 32% versus 33%, P = 0.94; early referrals: 68% versus 67%, P = 0.94). Of the 333 early referrals who were managed expectantly per guideline recommendations, 2 (0.6%) developed incarceration which was managed with successful reduction and interval repair. One-third of all referrals for umbilical hernia evaluation are potentially avoidable, and this rate did not change following release of American Academy of Pediatrics guidelines. Aligning expectations between surgeons and referring providers through improved education and guideline dissemination may reduce avoidable visits, lost caregiver productivity, and exposure to potentially avoidable surgery.
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影响因子：
2.1
作者：
Douglas, Catriona M.;Altmyer, Ursula;Clark, Louise J.
通讯作者：
Clark, Louise J.
影响因子：
2.6
作者：
Meier, DE;OlaOlorun, DA;Tarpley, JL
通讯作者：
Tarpley, JL
影响因子：
2.4
作者：
Shinkunas, Laura A.;Klipowicz, Caleb J.;Carlisle, Erica M.
通讯作者：
Carlisle, Erica M.
影响因子：
2.4
作者：
McEvoy, Christian S.;Ross-Li, Dan;Ricca, Robert L.
通讯作者：
Ricca, Robert L.
影响因子：
2.2
作者：
McSweeney, Lorraine A.;Wilson, Janet A.;Haighton, Catherine A.
通讯作者：
Haighton, Catherine A.