Biondo Sebastiano, Kreisler Esther, Millan Monica, Fraccalvieri Domenico, Golda Thomas, Frago Ricardo, Miguel Bernat
Department of Surgery, Bellvitge University Hospital, University of Barcelona, Spain.
Arch Surg. 2010 Jan;145(1):79-86. doi: 10.1001/archsurg.2009.208.
To evaluate the impact of surgeon specialization on emergency colorectal resection in terms of mortality, morbidity, and type of operation performed.
Observational study from January 1, 1993, through December 31, 2006.
Bellvitge University Hospital, Barcelona, Spain.
A total of 1046 patients underwent emergency colorectal resection. Patients were classified into 2 groups: those operated on by a colorectal surgeon (CS) and those operated on by a general surgeon (GS).
Preoperative variables studied were sex, age, American Society of Anesthesiologists grade, associated medical disease, presentation, reason for surgery, and type of operation. Univariate relations between predictors and outcomes were estimated, and multivariate logistic regression analysis was used to assess the prognostic effect of the combination of the variables.
Patients in the CS group underwent a significantly higher percentage of resection and primary anastomosis. The postoperative morbidity rate was 52.2% in the CS group and 60.5% in the GS group (P = .01). The anastomotic dehiscence rate was lower in the CS group (6.2%) than in the GS group (12.1%) (P = .01). Postoperative mortality decreased among patients in the CS group (17.9%) with respect to the patients in the GS group (28.3%) (P < .001). Being operated on by a CS was predictive in both the univariate and multivariate analyses for postoperative complications and mortality, and it was the only variable with predictive value for anastomotic dehiscence.
Specialization in colorectal surgery has a significant influence on morbidity, mortality, and anastomotic dehiscence after emergency operations.
从死亡率、发病率及所施行手术类型方面评估外科医生专业化对急诊结直肠切除术的影响。
1993年1月1日至2006年12月31日的观察性研究。
西班牙巴塞罗那的贝尔维奇大学医院。
共有1046例患者接受了急诊结直肠切除术。患者被分为两组：由结直肠外科医生（CS）施行手术的患者和由普通外科医生（GS）施行手术的患者。
所研究的术前变量包括性别、年龄、美国麻醉医师协会分级、相关内科疾病、临床表现、手术原因及手术类型。估计预测因素与结局之间的单变量关系，并采用多因素logistic回归分析评估变量组合的预后效应。
CS组患者接受切除及一期吻合术的比例显著更高。CS组术后发病率为52.2%，GS组为60.5%（P = 0.01）。CS组吻合口裂开率（6.2%）低于GS组（12.1%）（P = 0.01）。CS组患者术后死亡率（17.9%）相对于GS组患者（28.3%）有所降低（P < 0.001）。在单变量和多变量分析中，由CS施行手术均对术后并发症及死亡率具有预测作用，且是对吻合口裂开具有预测价值的唯一变量。
结直肠外科专业化对急诊手术后的发病率､死亡率及吻合口裂开有显著影响。
