Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2013 Jan;56(1):64-71. doi: 10.1097/DCR.0b013e31827175f6.
Surgical outcomes are determined by complex interactions among a variety of factors including patient characteristics, diagnosis, and type of procedure.
The aim of this study was to prioritize the effect and relative importance of the surgeon (in terms of identity of a surgeon and surgeon volume), patient characteristics, and the intraoperative details on complications of colorectal surgery including readmission, reoperation, sepsis, anastomotic leak, small-bowel obstruction, surgical site infection, abscess, need for transfusion, and portal and deep vein thrombosis.
This study uses a novel classification methodology to measure the influence of various risk factors on postoperative complications in a large outcomes database.
Using prospectively collected information from the departmental outcomes database from 2010 to 2011, we examined the records of 3552 patients who underwent colorectal surgery. Instead of traditional statistical methods, we used a family of 7000 bootstrap classification models to examine and quantify the impact of various factors on the most common serious surgical complications. For each complication, an ensemble of multivariate classification models was designed to determine the relative importance of potential factors that may influence outcomes of surgery. This is a new technique for analyzing outcomes data that produces more accurate results and a more reliable ranking of study variables in order of their importance in producing complications.
Patients who underwent colorectal surgery in 2010 and 2011 were included.
This study was conducted at a tertiary referral department at a major medical center.
Postoperative complications were the primary outcomes measured.
Factors sorted themselves into 2 groups: a highly important group (operative time, BMI, age, identity of the surgeon, type of surgery) and a group of low importance (sex, comorbidity, laparoscopy, and emergency). ASA score and diagnosis were of intermediate importance. The outcomes most influenced by variations in the highly important factors included readmission, transfusion, surgical site infection, and abscesses.
This study was limited by the use of data from a single tertiary referral department at a major medical center.
Body mass index, operative time, and the surgeon who performed the operation are the 3 most important factors influencing readmission rates, rates of transfusions, and surgical site infection. Identification of these contributing factors can help minimize complications.
手术结果取决于多种因素的复杂相互作用，包括患者特征、诊断和手术类型。
本研究旨在确定外科医生（包括外科医生的身份和手术量）、患者特征和手术过程中的细节对结直肠手术并发症（包括再入院、再次手术、脓毒症、吻合口漏、小肠梗阻、手术部位感染、脓肿、需要输血以及门静脉和深静脉血栓形成）的影响和相对重要性。
本研究使用一种新的分类方法来衡量各种风险因素对大型结果数据库中术后并发症的影响。
使用 2010 年至 2011 年从部门结果数据库中收集的前瞻性信息，我们检查了 3552 例接受结直肠手术的患者的记录。我们没有使用传统的统计方法，而是使用了一套 7000 个自举分类模型来检查和量化各种因素对最常见严重手术并发症的影响。对于每种并发症，我们设计了一个多变量分类模型的集合，以确定可能影响手术结果的潜在因素的相对重要性。这是一种用于分析结果数据的新技术，可产生更准确的结果，并更可靠地按其对产生并发症的重要性对研究变量进行排序。
纳入 2010 年和 2011 年接受结直肠手术的患者。
本研究在一家主要医疗中心的三级转诊部门进行。
术后并发症为主要测量结果。
因素分为 2 组：高度重要组（手术时间、BMI、年龄、外科医生的身份、手术类型）和低重要组（性别、合并症、腹腔镜检查、急诊）。ASA 评分和诊断处于中间重要性。受高度重要因素变化影响最大的结果包括再入院、输血、手术部位感染和脓肿。
本研究受到使用来自一家主要医疗中心的三级转诊部门的数据的限制。
体重指数、手术时间和手术医生是影响再入院率、输血率和手术部位感染率的 3 个最重要因素。确定这些致病因素有助于最大限度地减少并发症。
