Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
J Surg Res. 2012 May 15;174(2):192-9. doi: 10.1016/j.jss.2011.09.012. Epub 2011 Oct 6.
The tightening focus on optimizing surgical outcomes has pushed tracking perioperative mortality to the forefront of interest. The goal of this study is to analyze factors affecting mortality after colorectal resection at a single tertiary care center.
Data were collected from a prospective database for all patients undergoing a colorectal resection at our institution over a 12-y period. Data points included patient demographics, comorbidities, operative details, clinical presentation, postoperative complications, and mortality.
A total of 1245 patients were evaluated with 41 deaths (3.3%). Our population was 51% male with an average age of 60.1 ± 15.2 y, mean BMI of 27.5 ± 6.4 kg/m(2), average ASA score of 2.6 ± 0.9, and average of 2.2 ± 1.9 comorbidities. Preoperative factors associated with increased mortality included age, high ASA score, emergent surgery, and the presence of bowel perforation or obstruction (P < 0.05). Intra- and postoperative factors including the transfusion of blood products, length of resection, subtotal colectomy, open versus laparoscopic procedures, the need for reoperation, diagnosis and postoperative complications negatively impact survival (P < 0.05). Stepwise logistic regression demonstrated that high ASA score, emergent procedure, subtotal colectomy, age, obstruction, and open resection as the independent predictors of mortality in a stepwise logistic regression model (P < 0.10).
Preoperative ASA, emergent procedure, age, open procedure, subtotal colectomy, and obstruction were the independent predictors of mortality in our review. Preoperative optimization and counseling of elderly patients with a high ASA score and/or those requiring an emergency operation should be utilized by surgeons in an effort to improve surgical mortality and patient education.
优化手术结果的重点越来越集中，促使人们将围手术期死亡率的跟踪放在了首要关注的位置。本研究的目的是分析单中心接受结直肠切除术患者的死亡率影响因素。
在 12 年期间，我们从机构的前瞻性数据库中收集了所有接受结直肠切除术患者的数据。数据点包括患者的人口统计学、合并症、手术细节、临床表现、术后并发症和死亡率。
共有 1245 例患者接受评估，其中 41 例死亡（3.3%）。我们的患者人群中男性占 51%，平均年龄为 60.1±15.2 岁，平均 BMI 为 27.5±6.4kg/m2，平均 ASA 评分为 2.6±0.9，合并症平均为 2.2±1.9 个。与死亡率增加相关的术前因素包括年龄、高 ASA 评分、急诊手术以及肠穿孔或梗阻的存在（P<0.05）。术中及术后因素包括输血、切除长度、次全结肠切除术、开腹与腹腔镜手术、再次手术的需要、诊断及术后并发症均对生存造成负面影响（P<0.05）。逐步逻辑回归表明，高 ASA 评分、急诊手术、次全结肠切除术、年龄、梗阻和开腹手术是逐步逻辑回归模型中死亡率的独立预测因子（P<0.10）。
在我们的回顾中，术前 ASA、急诊手术、年龄、开放手术、次全结肠切除术和梗阻是死亡率的独立预测因子。外科医生应优化和指导术前高 ASA 评分和/或需要急诊手术的老年患者，以提高手术死亡率和患者教育。
