Ghorra S G, Rzeczycki T P, Natarajan R, Pricolo V E
Department of Surgery and Center for Statistical Sciences, Rhode Island Hospital and Brown University, Providence 02903, USA.
Am Surg. 1999 Mar;65(3):266-9.
The objective of this study was to stratify patients for colostomy closure into risk categories according to preoperative variables. This was a retrospective case series. Median follow-up was 82 months. A tertiary care academic medical center was the setting for this study. A study sample of 155 consecutive patients who underwent colostomy closure at a single institution between 1985 and 1995 were included in this study. The following preoperative variables were analyzed: indication for colostomy fashioning; age; gender; American Society of Anesthesiology (ASA) class; presence of cardiac, renal, or pulmonary dysfunctions; presence of diabetes mellitus; and immunosuppression. The occurrence of adverse outcome, as evidenced by postoperative morbidity and mortality, was used as the main outcome measure. Complications occurred in 49 patients (31.6%), including a 1.3 per cent mortality. There was a trend of increasing morbidity with increasing ASA class. The single factor that showed a statistically significant increase in morbidity was the presence of diabetes (P = 0.036). Predicted probabilities of complications for patients with ASA III with renal disease was 31 per cent, increased to 47.9 per cent if cardiac disease was also present and to 77 per cent with the addition of diabetes. The presence of diabetes carries an independent risk factor for adverse outcome in colostomy closure. This study provides information about stratification of postoperative risk based on commonly available preoperative variables. In the majority of cases, colostomy closure seems to carry a very acceptable complication rate. In selected patients with multiple preoperative risk factors, the morbidity becomes significantly higher.
本研究的目的是根据术前变量将结肠造口关闭术患者分层为不同风险类别。这是一项回顾性病例系列研究。中位随访时间为82个月。本研究以一家三级医疗学术医学中心为背景。研究样本包括1985年至1995年间在单一机构接受结肠造口关闭术的155例连续患者。分析了以下术前变量：结肠造口形成的指征；年龄；性别；美国麻醉医师协会（ASA）分级；心脏、肾脏或肺部功能障碍的存在；糖尿病的存在；以及免疫抑制。以术后发病率和死亡率为证据的不良结局的发生情况用作主要结局指标。49例患者（31.6%）发生了并发症，包括1.3%的死亡率。随着ASA分级的增加，发病率有上升趋势。显示发病率有统计学显著增加的单一因素是糖尿病的存在（P = 0.036）。患有肾脏疾病的ASA III级患者并发症的预测概率为31%，如果同时存在心脏疾病则增至47.9%，如果再加上糖尿病则增至77%。糖尿病的存在是结肠造口关闭术不良结局的独立危险因素。本研究提供了基于常见术前变量的术后风险分层信息。在大多数情况下，结肠造口关闭术似乎具有非常可接受的并发症发生率。在具有多种术前危险因素的特定患者中，发病率会显著更高。
