丹麦炎症性肠病患者择期和急诊全结肠切除术后30天死亡率：一项基于全国人口的队列研究。
Thirty-day mortality after elective and emergency total colectomy in Danish patients with inflammatory bowel disease: a population-based nationwide cohort study.
作者信息
Tøttrup Anders, Erichsen Rune, Sværke Claus, Laurberg Søren, Srensen Henrik Toft
机构信息
Department of Surgery P, Aarhus University Hospital, Aarhus C, Denmark.
出版信息
BMJ Open. 2012 Apr 5;2(2):e000823. doi: 10.1136/bmjopen-2012-000823. Print 2012.
OBJECTIVES
The purpose of this investigation was to assess 30-day mortality among Danish inflammatory bowel diseases (IBD) patients and to examine the prognostic impact of hospital total colectomy volume, age, gender and comorbidity.
DESIGN
Cohort study.
SETTING
The authors compared 30-day survival over the period 1996-2010 among 2889 IBD patients with total colectomy identified in the Danish National Registry of Patients. This registry covers all hospitals in Denmark. Postoperative survival patterns for patients with ulcerative colitis and Crohn's disease were compared, using proportional hazard regression. The regression model accounted for the timing of surgery, hospital total colectomy volume, age, gender and comorbidity.
PARTICIPANTS
Patients were enrolled in the study if they had a hospital registry diagnosis of IBD, with accompanying procedure codes for total colectomy (see codes in online appendix table 1). Hospitalisations were described as elective or emergency, and patients were categorised as having Crohn's disease, ulcerative colitis or as a mixed group.
OUTCOME MEASURES
Primary outcome measure was 30-day mortality.
RESULTS
Among 2889 IBD patients with total colectomy, 1439 (50%) underwent surgery during an emergency hospitalisation. Thirty-day mortality was 5.3% (76/1439) among emergency cases compared with 1% (14/1450) among elective cases. The highest mortality (8.1%; 11 of 136) was observed among Crohn's patients undergoing emergency surgery. The mortality of patients with ulcerative colitis undergoing emergency surgery was 5.2% (55/1056). After elective surgery, the 30-day mortality was 0.9% (8/938) among patients with ulcerative colitis and 1.5% (3/201) among Crohn's disease patients. Low hospital total colectomy volume, comorbidity and high age were associated with increased 30-day mortality in ulcerative colitis patients undergoing emergency surgery.
CONCLUSION
Emergency total colectomy among patients with ulcerative colitis and particularly Crohn's disease is associated with substantial 30-day mortality.
目的
本研究旨在评估丹麦炎症性肠病（IBD）患者的30天死亡率，并探讨医院全结肠切除术例数、年龄、性别及合并症对预后的影响。
设计
队列研究。
背景
作者比较了1996年至2010年期间丹麦国家患者登记处中确诊的2889例行全结肠切除术的IBD患者的30天生存率。该登记处涵盖丹麦所有医院。采用比例风险回归比较溃疡性结肠炎和克罗恩病患者的术后生存模式。回归模型考虑了手术时间、医院全结肠切除术例数、年龄、性别及合并症。
参与者
若患者在医院登记诊断为IBD，并伴有全结肠切除术的手术编码（见在线附录表1中的编码），则纳入本研究。住院分为择期或急诊，患者分为患有克罗恩病、溃疡性结肠炎或混合组。
观察指标
主要观察指标为30天死亡率。
结果
在2889例行全结肠切除术的IBD患者中，1439例（50%）在急诊住院期间接受手术。急诊病例的30天死亡率为5.3%（76/1439），而择期病例为1%（14/1450）。在接受急诊手术的克罗恩病患者中观察到最高死亡率（8.1%；136例中的11例）。接受急诊手术的溃疡性结肠炎患者死亡率为5.2%（55/1056）。择期手术后，溃疡性结肠炎患者的30天死亡率为0.9%（8/938），克罗恩病患者为1.5%（3/201）。医院全结肠切除术例数少、合并症及高龄与接受急诊手术的溃疡性结肠炎患者30天死亡率增加相关。
结论
溃疡性结肠炎患者尤其是克罗恩病患者的急诊全结肠切除术与较高的30天死亡率相关。
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