Peterson Carrie Y, Palazzi Kerrin, Parsons J Kellogg, Chang David C, Ramamoorthy Sonia L
Department of Surgery, University of California, San Diego, 3855 Health Sciences Dr., Suite 2073, La Jolla, CA, 92093, USA,
Surg Endosc. 2014 Feb;28(2):608-16. doi: 10.1007/s00464-013-3216-9. Epub 2013 Oct 4.
Although laparoscopic colorectal surgery is associated with faster postoperative recovery and shorter hospital stays than open surgery, perioperative patient safety analyses using process-focused, validated measures have yet to be performed.
This study analyzed the U.S. Nationwide Inpatient Sample, a 20 % weighted sample of inpatient hospital discharges, from 1998 to 2009. The study included patients who underwent open or laparoscopic colorectal resections and excluded those younger than 18 years and those who underwent emergent or multiple colorectal operations. The primary outcome measure was surgery-specific patient safety indicators (PSIs). Uni- and multivariate regression methods were used to estimate associations of surgery type with PSIs.
A total of 2,936,641 patients were identified, and 177,547 (6 %) of these patients underwent laparoscopic colorectal resections. The laparoscopic patients were younger (p < 0.001) and more likely to be Caucasian (p = 0.005) and male (p < 0.001), to have lower Charlson scores (p < 0.001), and to undergo surgery in teaching hospitals (p < 0.001) located in urban areas (p < 0.001). The prevalence of laparoscopic surgery has increased rapidly in recent years, from 5 to 29 % of all colorectal procedures performed in 2007 and 2009, respectively. The prevalence of any PSI was lower in the laparoscopic group (4.2 vs. 8.3 %; p < 0.001). Multivariate analyses showed that the likelihood of any PSI for laparoscopic colorectal resection was 57 % lower than for open resections (odds ratio, 0.43; 95 % confidence interval, 0.40-0.46; p < 0.001).
Laparoscopic colorectal surgery was associated with a lower risk of adverse patient safety events, a difference that became more pronounced as the prevalence of laparoscopy increased. Future studies should focus on factors that promote the safe adoption of innovative surgical techniques and optimize surgical outcomes.
尽管与开放手术相比，腹腔镜结直肠手术术后恢复更快、住院时间更短，但尚未使用以流程为重点的有效措施对围手术期患者安全进行分析。
本研究分析了1998年至2009年美国全国住院患者样本，这是一个对住院患者出院情况进行20%加权的样本。该研究纳入了接受开放或腹腔镜结直肠切除术的患者，排除了年龄小于18岁的患者以及接受急诊或多次结直肠手术的患者。主要结局指标是手术特异性患者安全指标（PSI）。采用单因素和多因素回归方法来估计手术类型与PSI之间的关联。
共识别出2936641例患者，其中177547例（6%）接受了腹腔镜结直肠切除术。接受腹腔镜手术的患者更年轻（p<0.001），更可能是白种人（p=0.005）和男性（p<0.001），Charlson评分更低（p<0.001），且在位于城市地区（p<0.001）的教学医院接受手术（p<0.001）。近年来，腹腔镜手术的普及率迅速上升，在2007年和2009年分别占所有结直肠手术的5%和29%。腹腔镜组中任何PSI的发生率较低（4.2%对8.3%；p<0.001）。多因素分析显示，腹腔镜结直肠切除术发生任何PSI的可能性比开放切除术低57%（优势比，0.43；95%置信区间，0.40 - 0.46；p<0.001）。
腹腔镜结直肠手术与不良患者安全事件风险较低相关，随着腹腔镜检查普及率的增加，这种差异变得更加明显。未来的研究应关注促进安全采用创新手术技术并优化手术结果的因素。
