Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2009 Nov;52(11):1848-53. doi: 10.1007/DCR.0b013e3181b15610.
This study was designed to evaluate factors that might be predictive of readmission and early and long-term outcomes for patients readmitted after ileal pouch-anal anastomosis.
Data for patients readmitted within 30 days after ileal pouch-anal anastomosis were identified from a prospectively maintained database and compared with the remaining patients. Early and delayed outcomes for readmitted patients, including long-term functional outcomes and quality of life, were evaluated. Potential predictors of readmission were assessed using a multivariate analysis of factors.
Of 3,410 patients who underwent ileal pouch-anal anastomosis from 1984 to 2008, 410 (12%) were readmitted. Reasons for readmission included ileus, obstruction or dyselectrolytemia (54.9%), surgical site infection (19.8%), anastomotic problems (9.8%), and thrombotic (3.4%), hemorrhagic (3.2%), infectious (2.9%), cardiac (1.2%), and miscellaneous (4.3%) complications. Thirty-two (7.8%) patients underwent reoperation; 74 (18%) required invasive nonoperative interventions. Median hospital stay for readmission was four (range, 1-52) days. Readmitted patients had worse long-term functional results (P = 0.015) and social (P = 0.024), work (P = 0.008), and sexual (P = 0.046) restriction as compared with patients who were not readmitted. The Cleveland Global Quality of Life (P = 0.018) and physical SF-36 (P = 0.008) scores were also significantly lower for readmitted patients. On multivariate analysis, comorbid conditions (P = 0.014, odds ratio = 1.36), laparoscopic technique (P = 0.008, odds ratio = 1.8), proctocolectomy (rather than initial subtotal colectomy) at ileal pouch-anal anastomosis (P < 0.001, odds ratio = 1.55), and postoperative blood transfusion (P = 0.02, odds ratio = 1.54) were independently associated with readmission.
Early readmission after ileal pouch-anal anastomosis is common. Associated comorbidity, laparoscopic approach, reconstruction of the ileal pouch-anal anastomosis at the index surgery, and postoperative blood transfusion are associated with readmission.
本研究旨在评估影响回肠贮袋肛管吻合术后患者再入院及早期和长期结局的因素。
从一个前瞻性维护的数据库中确定了在回肠贮袋肛管吻合术后 30 天内再入院的患者的数据，并与其余患者进行比较。评估了再入院患者的早期和延迟结局，包括长期功能结局和生活质量。使用多因素分析评估再入院的潜在预测因素。
1984 年至 2008 年间，3410 例患者接受了回肠贮袋肛管吻合术，其中 410 例（12%）再入院。再入院的原因包括肠梗阻、梗阻或电解质紊乱（54.9%）、手术部位感染（19.8%）、吻合口问题（9.8%）、血栓形成（3.4%）、出血（3.2%）、感染（2.9%）、心脏（1.2%）和其他（4.3%）并发症。32 例（7.8%）患者接受了再次手术；74 例（18%）需要进行侵入性非手术干预。再入院患者的中位住院时间为 4 天（范围 1-52 天）。与未再入院的患者相比，再入院患者的长期功能结果（P=0.015）、社会（P=0.024）、工作（P=0.008）和性生活（P=0.046）受限更为严重。克利夫兰全球生活质量（P=0.018）和身体 SF-36（P=0.008）评分也明显更低。多因素分析显示，合并症（P=0.014，比值比=1.36）、腹腔镜技术（P=0.008，比值比=1.8）、回肠贮袋肛管吻合术时行直肠切除术（而非初始次全结肠切除术）（P＜0.001，比值比=1.55）和术后输血（P=0.02，比值比=1.54）与再入院独立相关。
回肠贮袋肛管吻合术后早期再入院很常见。相关合并症、腹腔镜方法、指数手术中回肠贮袋肛管吻合术的重建和术后输血与再入院相关。
