title: Application of the procedural consolidation concept to surgical treatment of children with epidermolysis bullosa: a retrospective analysis.
abstract: OBJECTIVE
  To assess the efficacy of the procedural consolidation concept (PCC) at reducing the number of sessions of general anesthesia necessary for treating children with epidermolysis bullosa (EB).
  
  
  METHODS
  We examined the records of children treated at Children's Hospital of Zagreb between April 1999 and December 2007. Children treated before the introduction of PCC in January 2005 (n=39) and after (n=48) were analyzed in order to determine the effect of PCC on the occurrence of complications, days of hospitalization, and number of hospitalizations.
  
  
  RESULTS
  During the study period, 53 patients underwent 220 sessions of general anesthesia for a total of 743 surgical interventions per session. Before the introduction of PCC (n=39 patients, 83 sessions), the median number of interventions per session was 2 (range 1-5), and after the introduction of PCC (n=48 patients, 137 sessions) it was 4 (range 3-7, P<0.001). After the introduction of PCC, the median number of complications per anesthesia session increased from 2 (range 0-10) to 3 (range 0-10) (P=0.027), but the median number of complications per surgical procedure decreased from 1 (range 0-10) to 0.6 (range 0-2.5) (P<0.001). PCC lengthened each anesthesia session from a median of 65 minutes (range 35-655) to 95 minutes (range 50-405), (P<0.001). Total length of hospitalization was similar before (median 1, range 1-4) and after (median 1, range 1-3) introduction of PCC (P=0.169). The number of hospitalization days per procedure was 3 times lower after the introduction of PCC (median 0.3, range 0.2-3) than before (median 1, range 0.75-1.7) (P<0.001).
  
  
  CONCLUSIONS
  PCC should be considered an option in the surgical treatment of children with EB.
authors.affiliation: Maja Karaman Ilic, Siget 18 b, 10020 Zagreb, Croatia. mkilic@inet.hr
authors.forename: Maja
authors.initials: M
authors.lastname: Karaman Ilić
authors.forename: Josipa
authors.initials: J
authors.lastname: Kern
authors.forename: Irena
authors.initials: I
authors.lastname: Babić
authors.forename: Diana
authors.initials: D
authors.lastname: Simić
authors.forename: Antun
authors.initials: A
authors.lastname: Kljenak
authors.forename: Visnja
authors.initials: V
authors.lastname: Majerić Kogler
mesh_terms: D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004820:Epidermolysis Bullosa / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult