Department of Surgery, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):878-83. doi: 10.1097/TA.0b013e31824d0f70.
Colectomy patients experience a broad set of adverse outcomes. Complications requiring critical care support are common in this group. We hypothesized that as frailty increases, the risk of Clavien class IV and V complications will increase in colectomy patients.
Using the National Surgical Quality Improvement Program (NSQIP) participant use files for 2005-2009, we identified patients who underwent laparoscopic and open colectomies by Current Procedural Terminology code. Using the Clavien classification for postoperative complications, we identified NSQIP data points most consistent with Clavien class IV requiring intensive care unit (ICU) care or class V complications (death). We used a modified frailty index with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index and existing NSQIP variables. Logistic regression was performed to acuity adjust the findings.
A total of 58,448 colectomies were identified. As frailty index increased from 0 to 0.55, the proportion of those experiencing Clavien class IV or V complications increased from 3.2% at baseline to 56.3%. Variables found to be significant by logistic regression (odds ratio) were frailty index (14.4; p = 0.001), open procedure (2.35; p < 0.001), and American Society of Anesthesiologists class 4 (3.2; p = 0.038) or 5 (7.1; p = 0.001) while emergency operation and wound classification 3 or 4 were not.
Complications requiring ICU care represent a significant morbidity in the colectomy patient population. Frailty index seems to be an important predictor of ICU-level complications and death, and laparoscopy seems to be protective.
结肠切除术患者会经历一系列不良后果。该类患者中，需要重症监护支持的并发症较为常见。我们假设，随着虚弱程度的增加，结肠切除术患者发生 Clavien 四级和五级并发症的风险将会增加。
利用 2005-2009 年国家外科质量改进计划（NSQIP）参与者使用文件，我们通过当前操作术语（Current Procedural Terminology）代码确定接受腹腔镜和开腹结肠切除术的患者。使用术后并发症的 Clavien 分类，我们确定了与需要重症监护病房（ICU）护理的 NSQIP 数据点最一致的 Clavien 四级分类或五级并发症（死亡）。我们使用了基于加拿大健康老龄化虚弱指数和现有 NSQIP 变量映射的 11 个变量的改良虚弱指数。使用逻辑回归进行敏锐度调整。
共确定了 58448 例结肠切除术。随着虚弱指数从 0 增加到 0.55，经历 Clavien 四级或五级并发症的比例从基线时的 3.2%增加到 56.3%。逻辑回归（比值比）确定的显著变量为虚弱指数（14.4；p = 0.001）、开腹手术（2.35；p < 0.001）和美国麻醉师协会（American Society of Anesthesiologists）分类 4 级（3.2；p = 0.038）或 5 级（7.1；p = 0.001），而紧急手术和伤口分类 3 级或 4 级则不是。
需要 ICU 护理的并发症是结肠切除术患者人群中一个显著的发病率。虚弱指数似乎是 ICU 级并发症和死亡的重要预测指标，而腹腔镜手术似乎具有保护作用。
