Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Dis Colon Rectum. 2010 Nov;53(11):1508-16. doi: 10.1007/DCR.0b013e3181e8fc8e.
The risk of abdominal surgery in patients with end-stage renal failure is poorly defined. Our objective was to describe outcomes of colorectal surgery in dialysis patients from a population-based perspective.
We analyzed the 1993 to 2007 Nationwide Inpatient Sample to identify patients hospitalized for colorectal surgery. The effect of renal failure on mortality, complications, length of stay, and charges was evaluated using logistic regression models.
Between 1993 and 2007, there were 755,343 admissions for colorectal surgery in the Nationwide Inpatient Sample database; 5806 patients (0.77%) were receiving dialysis treatment (87.4% hemodialysis, 4.9% peritoneal dialysis, 7.7% method not specified). Patients undergoing dialysis had an increased risk of mortality (22.1% vs 2.8%; adjusted OR 4.83; 95% CI 4.58-5.31) and complications (52.1% vs 34.0%; adjusted OR 2.04; 95% CI 1.90-2.17). Dialysis patients undergoing nonelective procedures had a 2-fold higher mortality rate than patients having had elective surgery (25.5% vs 10.3%; adjusted OR 2.01; 95% CI 1.65-2.43). In nonelective surgery, independent predictors of mortality included procedures with an end-stoma (adjusted OR 1.86; 95% CI 1.58-2.18), age over 60 (adjusted OR 1.73; 95% CI 1.43-2.08), total colectomy (adjusted OR 1.68; 95% CI 1.27-2.22), vascular insufficiency as surgical indication (adjusted OR 1.58; 95% CI 1.32-1.90), nonprivate insurance coverage (adjusted OR 1.38; 95% CI 1.07-1.77) and malnutrition (adjusted OR 1.26; 95% CI 1.01-1.59).
Patients receiving dialysis treatment have an increased risk of morbidity and mortality following colorectal surgery. Elective procedures are associated with a 10% rate of mortality in this population. Dialysis patients are especially susceptible to infectious and pulmonary complications after colorectal resection. Additional studies are necessary to refine risk stratification in this high-risk patient population.
终末期肾病患者行腹部手术的风险尚不清楚。本研究的目的是从人群角度描述透析患者行结直肠手术的结局。
我们分析了 1993 年至 2007 年全国住院患者样本，以确定因结直肠手术住院的患者。使用 logistic 回归模型评估肾功能衰竭对死亡率、并发症、住院时间和费用的影响。
1993 年至 2007 年间，全国住院患者样本数据库中共有 755343 例结直肠手术；5806 例（0.77%）患者正在接受透析治疗（87.4%血液透析、4.9%腹膜透析、7.7%方法未指定）。接受透析的患者死亡率（22.1%比 2.8%；校正后 OR 4.83；95%CI 4.58-5.31）和并发症（52.1%比 34.0%；校正后 OR 2.04；95%CI 1.90-2.17）的风险增加。行非择期手术的透析患者的死亡率是择期手术患者的两倍（25.5%比 10.3%；校正后 OR 2.01；95%CI 1.65-2.43）。在非择期手术中，死亡率的独立预测因素包括有造口术的手术（校正后 OR 1.86；95%CI 1.58-2.18）、年龄大于 60 岁（校正后 OR 1.73；95%CI 1.43-2.08）、全结肠切除术（校正后 OR 1.68；95%CI 1.27-2.22）、血管功能不全作为手术指征（校正后 OR 1.58；95%CI 1.32-1.90）、非私人保险（校正后 OR 1.38；95%CI 1.07-1.77）和营养不良（校正后 OR 1.26；95%CI 1.01-1.59）。
接受透析治疗的患者在结直肠手术后有更高的发病率和死亡率。在该人群中，择期手术的死亡率为 10%。透析患者在结直肠切除术后尤其容易发生感染和肺部并发症。需要进一步研究来细化这一高危患者人群的风险分层。
