Hollenbeck Brent K, Miller David C, Taub David, Dunn Rodney L, Khuri Shukri F, Henderson William G, Montie James E, Underwood Willie, Wei John T
Department of Urology, The University of Michigan, Ann Arbor, Michigan, USA.
J Urol. 2005 Oct;174(4 Pt 1):1231-7; discussion 1237. doi: 10.1097/01.ju.0000173923.35338.99.
Morbidity after radical cystectomy is common and associated with increased health care resource use. Accurate characterization of complications after cystectomy, associated patient specific risk factors, and perioperative processes of care are essential to directing changes in perioperative management that will reduce morbidity and improve the quality of patient care.
The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. The NSQIP collects clinical information, intraoperative data and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomy procedures have been captured by the NSQIP. Modeling using logistic regression was performed to identify patient specific risk factors and perioperative process measures associated with postoperative morbidity.
Of the 2,538 subjects at least 1 postoperative complication developed in 774 (30.5%). The most frequent complication was ileus (10%). Several factors were associated with the development of a complication, including age, dependent functional status, preoperative dyspnea, preoperative acute renal failure, chronic steroid use, preoperative alcohol consumption, American Society of Anesthesiology score, use of general anesthetic, operative time, intraoperative blood requirement and surgeon level of training.
Morbidity remains high after cystectomy with 30.5% of subjects experiencing at least 1 complication. Measurable patient specific risk factors and perioperative processes associated with postoperative morbidity following cystectomy are now delineated which allows for improved risk stratification, patient counseling, and the development of novel processes that may incrementally reduce risk and improve outcomes.
根治性膀胱切除术后的发病率很常见，且与医疗资源使用增加相关。准确描述膀胱切除术后的并发症、相关的患者特异性风险因素以及围手术期护理过程，对于指导围手术期管理的改变至关重要，这些改变将降低发病率并提高患者护理质量。
国家外科质量改进计划（NSQIP）是一项针对全国123家退伍军人事务医疗中心的前瞻性质量管理倡议。NSQIP收集来自多个外科领域的各种手术程序的临床信息、术中数据和结果。自1991年以来，NSQIP已记录了2538例根治性膀胱切除术。使用逻辑回归进行建模，以确定与术后发病率相关的患者特异性风险因素和围手术期过程指标。
在2538名受试者中，774人（30.5%）至少发生了1种术后并发症。最常见的并发症是肠梗阻（10%）。有几个因素与并发症的发生相关，包括年龄、依赖性功能状态、术前呼吸困难、术前急性肾衰竭、长期使用类固醇、术前饮酒、美国麻醉医师协会评分、使用全身麻醉、手术时间、术中需血量和外科医生的培训水平。
膀胱切除术后发病率仍然很高，30.5%的受试者至少发生1种并发症。现在已经明确了与膀胱切除术后发病率相关的可测量的患者特异性风险因素和围手术期过程，这有助于改善风险分层、患者咨询，并开发可能逐步降低风险和改善结果的新流程。
