Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
J Surg Res. 2011 Nov;171(1):e9-13. doi: 10.1016/j.jss.2011.06.052. Epub 2011 Jul 23.
All open and laparoscopic colectomies submitted to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were evaluated for trends and improvements in operative outcomes.
48,247 adults (≥18 y old) underwent colectomy in ACS NSQIP, as grouped by surgical approach (laparoscopic versus open), urgency (emergent versus elective), and operative year (2005 to 2008). Primary outcomes measured morbidity, mortality, perioperative, and postoperative complications.
The proportion of laparoscopic colectomies performed increased annually (26.3% to 34.0%), while open colectomies decreased (73.7% to 66.0%; P < 0.0001). Most emergent colectomies were open procedures (93.5%) representing 24.3% of all open cases. The overall risk-adjusted morbidity and mortality for all colectomy procedures did not show a statistically significant change over time, however, morbidity and mortality increased among open colectomies (r = 0.03) and decreased among laparoscopic colectomies (r = -0.04; P < 0.0001). Postoperative complications reduced significantly including superficial surgical site infections (9.17% to 8.20%, P < 0.004), pneumonia (4.60% to 3.97%, P < 0.0001), and sepsis (4.72%, 2005; 6.81%, 2006; 5.62%, 2007; 5.09%, 2008; P < 0.0002). Perioperative improvements included operative time (169.2 to 160.0 min), PRBC transfusions (0.27 to 0.25 units) and length of stay (10.5 to 6.61 d; P < 0.0001).
It appears that laparoscopic colectomies are growing in popularity over open colectomies, but the need for emergent open procedures remains unchanged. Across all colectomies, however, key postoperative and perioperative complications have improved over time. Participation in ACS NSQIP demonstrates quality improvement and may encourage greater enrollment.
所有提交给美国外科医师学院国家外科质量改进计划（ACS NSQIP）的开放和腹腔镜结肠切除术都评估了手术结果的趋势和改善情况。
ACS NSQIP 对 48247 名成年人（≥18 岁）进行结肠切除术，按手术方法（腹腔镜与开放）、紧急程度（紧急与择期）和手术年份（2005 年至 2008 年）分组。主要结果测量发病率、死亡率、围手术期和术后并发症。
腹腔镜结肠切除术的比例逐年增加（26.3%至 34.0%），而开放结肠切除术则减少（73.7%至 66.0%；P<0.0001）。大多数紧急结肠切除术是开放手术（93.5%），占所有开放手术的 24.3%。所有结肠切除术的风险调整发病率和死亡率随时间推移没有统计学意义上的变化，但开放结肠切除术的发病率和死亡率增加（r=0.03），腹腔镜结肠切除术的发病率和死亡率降低（r=-0.04；P<0.0001）。术后并发症显著减少，包括浅表手术部位感染（9.17%至 8.20%，P<0.004）、肺炎（4.60%至 3.97%，P<0.0001）和脓毒症（4.72%，2005 年；6.81%，2006 年；5.62%，2007 年；5.09%，2008 年；P<0.0002）。围手术期的改善包括手术时间（169.2 分钟至 160.0 分钟）、PRBC 输血（0.27 单位至 0.25 单位）和住院时间（10.5 天至 6.61 天；P<0.0001）。
腹腔镜结肠切除术的受欢迎程度似乎超过了开放结肠切除术，但紧急开放手术的需求保持不变。然而，所有结肠切除术的关键术后和围手术期并发症随时间推移有所改善。参与 ACS NSQIP 表明质量得到了改善，并可能鼓励更多的参与。
