Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg. 2010 Mar;251(3):436-40. doi: 10.1097/SLA.0b013e3181cf8814.
Few studies have evaluated factors that may be associated with the development of septic complications after restorative proctocolectomy. Therefore, the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative proctocolectomy.
Patients developing abdominal and pelvic septic complications after restorative proctocolectomy were identified from a prospective database. Patients with subclinical leaks and ileostomy closure leak were not included in the septic complication group. A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P < 0.05.
From 1983 to 2007, 3233 patients (56% male) were included in the database. Eight-four percent (2597) of patients underwent proximal diversion. Two hundred patients (6.2%) developed septic complications within 3 months of restorative proctocolectomy or within 3 months of ileostomy closure. On multivariate analysis, body mass index > 30 (P = 0.02, OR = 1.77), final pathologic diagnosis of ulcerative/indeterminate colitis (P = 0.02, OR = 2) or Crohn's disease (P = 0.02, OR = 3.6), intraoperative (P = 0.02, OR = 1.6), and postoperative transfusions (P = 0.01, OR = 1.9) were all independently associated with septic complications. We also demonstrated an independent association among individual surgeons (P = 0.04) with decreased septic complications.
Body mass index greater than 30, final pathologic diagnosis of ulcerative/indeterminate colitis or Crohn's disease, intraoperative and postoperative transfusions, and surgeon were all independent factors associated with septic complications after restorative proctocolectomy.
鲜有研究评估可能与直肠结肠切除术后发生脓毒症并发症相关的因素。因此，本研究旨在评估与直肠结肠切除术后发生脓毒症并发症相关的术前和手术因素。
从前瞻性数据库中确定直肠结肠切除术后发生腹部和盆腔脓毒症并发症的患者。未将亚临床漏和回肠造口关闭漏患者纳入脓毒症并发症组。使用前进逐步选择法构建脓毒症的多变量逻辑回归模型，纳入标准为 P<0.05。
1983 年至 2007 年间，数据库中纳入 3233 例患者（56%为男性）。84%（2597 例）患者行近端转流。200 例（6.2%）患者在直肠结肠切除术后 3 个月内或回肠造口关闭后 3 个月内发生脓毒症并发症。多变量分析显示，体重指数（BMI）>30（P=0.02，OR=1.77）、最终病理诊断为溃疡性/不确定结肠炎（P=0.02，OR=2）或克罗恩病（P=0.02，OR=3.6）、术中（P=0.02，OR=1.6）和术后输血（P=0.01，OR=1.9）均与脓毒症并发症独立相关。我们还发现，个别外科医生之间存在独立相关性（P=0.04），其与脓毒症并发症减少相关。
BMI>30、最终病理诊断为溃疡性/不确定结肠炎或克罗恩病、术中及术后输血以及外科医生均为直肠结肠切除术后发生脓毒症并发症的独立因素。
