Surgical repair of bladder exstrophy in the modern era: Contemporary practice patterns and the role of hospital case volume
Surgical repair of bladder exstrophy in the modern era: Contemporary practice patterns and the role of hospital case volume
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DOI：
10.1097/01.ju.0000169132.14799.33
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发表时间：
2005-09-01
影响因子：
6.6
通讯作者：
Gearhart, JP
中科院分区：
文献类型：
--
作者：
Nelson, CP;Dunn, RL;Gearhart, JP
目的：膀胱外翻是一种罕见的疾病，缺乏关于其外科治疗的实践模式的资料。我们使用了一个全国性的大型数据库来调查膀胱外翻修复的实践模式。材料和方法：我们使用全国住院患者样本（1988 - 2000）来识别接受膀胱外翻手术修复的患者（国际疾病分类-9代码578.6）。我们分析了影响练习模式和结果的因素。医院数量基于参与研究的最高数量年份的病例量（高数量5例或更多，中数量3至4例，低数量少于3例）。结果：共鉴定407例。大约一半的患者（53.2%）在出生后24小时内住院，尽管28%的患者年龄大于1岁。其中男性占54%。外翻修复是一项资源密集的工作。在该系列中，平均住院时间（LOS）为24.6±22.8天，经通货膨胀调整后的平均住院费用为62,302美元（中位数为39,978美元）。大容量医院（HVHs）的住院费用（37,370美元）低于中等容量医院（51,778美元）或小容量医院（LVHs, 50,474美元，p = 0.0095）。在多元回归中，即使控制了其他重要的预测因素，包括LOS， HVHs的收费也较低
Purpose: Bladder exstrophy is a rare condition, and data are lacking regarding practice patterns in its surgical management. We used a large nationwide database to investigate practice patterns of bladder exstrophy repair.Materials and Methods: We used the Nationwide Inpatient Sample (1988 to 2000) to identify patients who underwent surgical repair of bladder exstrophy (International Classification of Disease-9 code 578.6). We analyzed factors affecting practice patterns and outcomes. Hospital volume was based on caseload during the highest volume year of study participation (high volume 5 or more, mid volume 3 to 4 and low volume less than 3 cases).Results: We identified 407 cases. Approximately half of the patients (53.2%) were hospitalized within 24 hours of birth, although 28% of patients were older than 1 year. Of the patients 54% were male. Exstrophy repair is extremely resource intensive. In this series mean length of hospital stay (LOS) was 24.6 +/- 22.8 days, and mean inflation adjusted hospital charges were $62,302 (median $39,978). High volume hospitals (HVHs) had lower hospital charges ($37,370) than mid volume ($51,778) or low volume hospitals (LVHs, $50,474, p = 0.0095). On multivariate regression HVHs had lower charges even after controlling for other significant predictors, including LOS (p