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1.
Int J Pediatr Otorhinolaryngol ; 117: 51-56, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30579088

RESUMO

OBJECTIVES: Numerous risk factors have been characterized for acquired subglottic stenosis (ASGS) in the pediatric population. This analysis explores the comorbidities of hospitalized ASGS patients in the United States and associated costs and length of stay (LOS). METHODS: A retrospective analysis of the Kids' Inpatient Database (KID) from 2009 to 2012 for inpatients ≤ 20 years of age who were diagnosed with ASGS. International Classification of Diseases, Clinical Modification, Version 9 diagnosis codes were used to extract diagnoses of interest from 14, 045, 425 weighted discharges across 4179 hospitals in the United States. An algorithm was created to identify the most common co-diagnoses and subsequently evaluated for total charges and LOS. RESULTS: ASGS was found in 7981 (0.06%) of total discharges. The mean LOS in discharges with ASGS is 13.11 days while the mean total charge in discharges with ASGS is $114,625; these values are significantly greater in discharges with ASGS than discharges without ASGS. Patients with ASGS have greater odds of being co-diagnosed with gastroesophageal reflux, Trisomy 21, other upper airway anomalies and asthma, while they have lower odds of being diagnosed with prematurity and dehydration. Aside from Trisomy 21 and asthma, hospitalizations of ASGS patients with the aforementioned comorbidities incurred a greater LOS and mean total charge. CONCLUSION: Our analysis identifies numerous comorbidities in children with ASGS that are associated with increased resource utilization amongst US hospitalizations. The practicing otolaryngologist should continue to advocate interdisciplinary care and be aware of the need for future controlled studies that investigate the management of such comorbidities.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Preços Hospitalares/estatística & dados numéricos , Laringoestenose/epidemiologia , Tempo de Internação/estatística & dados numéricos , Adolescente , Asma/economia , Asma/epidemiologia , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Desidratação/economia , Desidratação/epidemiologia , Síndrome de Down/economia , Síndrome de Down/epidemiologia , Refluxo Gastroesofágico/economia , Humanos , Lactente , Recém-Nascido , Classificação Internacional de Doenças , Laringoestenose/economia , Tempo de Internação/economia , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Anormalidades do Sistema Respiratório/economia , Anormalidades do Sistema Respiratório/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
2.
J Pediatr Surg ; 51(9): 1414-20, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27292597

RESUMO

PURPOSE: We sought to determine factors influencing survival and resource utilization in patients undergoing surgical resection of congenital lung malformations (CLM). Additionally, we used propensity score-matched analysis (PSMA) to compare these outcomes for thoracoscopic versus open surgical approaches. METHODS: Kids' Inpatient Database (1997-2009) was used to identify congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS) patients undergoing resection. Open and thoracoscopic CPAM resections were compared using PSMA. RESULTS: 1547 cases comprised the cohort. In-hospital survival was 97%. Mortality was higher in small vs. large hospitals, p<0.005. Survival, pneumothorax (PTX), and thoracoscopic procedure rates were higher, while transfusion rates and length of stay (LOS) were lower, in children ≥3 vs. <3months (p<0.001). Multivariate analysis demonstrated longer LOS for older patients and Medicaid patients (all p<0.005). Total charges (TC) were higher for Western U.S., older children, and Medicaid patients (p<0.02). PSMA for thoracoscopy vs. thoracotomy in CPAM patients showed no difference in outcomes. CONCLUSION: CLM resections have high associated survival. Children <3months of age had higher rates of thoracotomy, transfusion, and mortality. Socioeconomic status, age, and region were independent indicators for resource utilization. Extent of resection was an independent prognostic indicator for in-hospital survival. On PSMA, thoracoscopic resection does not affect outcomes.


Assuntos
Mortalidade Hospitalar , Pulmão/anormalidades , Pneumonectomia , Anormalidades do Sistema Respiratório/cirurgia , Toracoscopia , Toracotomia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Pulmão/cirurgia , Masculino , Análise Multivariada , Pneumonectomia/economia , Pneumonectomia/métodos , Pneumonectomia/mortalidade , Pontuação de Propensão , Anormalidades do Sistema Respiratório/economia , Anormalidades do Sistema Respiratório/mortalidade , Estudos Retrospectivos , Toracoscopia/economia , Toracoscopia/mortalidade , Toracotomia/economia , Toracotomia/mortalidade , Resultado do Tratamento , Estados Unidos , Adulto Jovem
3.
Equine Vet J ; 40(5): 508-13, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18490236

RESUMO

REASONS FOR PERFORMING THE STUDY: There have been no reports of the efficacy of thermocautery of the soft palate (TSP) assessed objectively as a treatment of intermittent dorsal displacement of the soft palate (DDSP). OBJECTIVE: To compare: racing performance of horses that underwent thermocautery of the soft palate with matched controls; and 'Racing Post ratings' (RPR) with prize money won (RE) and a performance index (PI) for each of the horses in the study. HYPOTHESIS: Thermocautery of the soft palate has no beneficial effect on racing performance and the 3 measures of performance are significantly related. METHODS: The inclusion criteria were fulfilled by 110 horses and each was matched with 2 controls. Changes in performance were compared statistically. RPR, RE and PI were analysed using a regression model. RESULTS: The percentage of horses that improved in performance following the procedure was 28-51% for the 3 measures of performance, compared to 21-53% for the matched controls. There was no significant effect of the procedure on the changes in RPR or RE. There was a significant effect of the procedure on the change in PI (P=0.015) with more treated horses achieving an improved PI and fewer acquiring a worse PI than matched control horses. The measures of performance showed significant correlation. CONCLUSIONS: Thermocautery of the soft palate alone may not be the most efficacious treatment of DDSP. POTENTIAL RELEVANCE: Production of a reliable measure of racehorse performance may be possible.


Assuntos
Cauterização/veterinária , Doenças dos Cavalos/cirurgia , Palato Mole/anormalidades , Palato Mole/cirurgia , Condicionamento Físico Animal , Anormalidades do Sistema Respiratório/veterinária , Esportes/economia , Animais , Estudos de Casos e Controles , Cauterização/métodos , Análise Custo-Benefício , Epiglote/anormalidades , Epiglote/cirurgia , Medicina Baseada em Evidências , Feminino , Doenças dos Cavalos/economia , Cavalos , Laringe/anormalidades , Laringe/diagnóstico por imagem , Laringe/cirurgia , Masculino , Condicionamento Físico Animal/economia , Condicionamento Físico Animal/fisiologia , Radiografia , Anormalidades do Sistema Respiratório/economia , Anormalidades do Sistema Respiratório/cirurgia , Resultado do Tratamento
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