1Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California 2Department of Statistics, University of California, Irvine, Irvine, California.
Dis Colon Rectum. 2014 Feb;57(2):179-86. doi: 10.1097/DCR.0000000000000033.
Iatrogenic ureteral injuries during colorectal surgical procedures are rare. Little is known about their incidence, associated outcomes, and predisposing factors.
The purpose of this study was to examine the trends of iatrogenic ureteral injuries in the United States over a decade, as well as their outcomes and risk factors.
This was a retrospective study.
The nationwide inpatient sample from 2001 to 2010 was analyzed.
Included were patients with colorectal cancer, benign polyps, diverticular disease, or inflammatory bowel disease undergoing colorectal surgery.
Trends of iatrogenic ureteral injuries occurring in colon and rectal surgical procedures were examined over a 10-year period. Mortality, morbidity, length of stay and total charge associated with ureteral injuries were analyzed on multivariate analysis. Finally, a predictive model for ureteral injuries was built using patient, hospital, and operative variables.
An estimated 2,165,848 colorectal surgical procedures were performed in the United States over the study period, and 6027 ureteral injuries were identified (0.28%). The rate of ureteral injuries was higher in the second half of the decade (2006-2010) compared with the first half (2001-2005; 3.1/1000 vs 2.5/1000; p < 0.001). Ureteral injuries were independently associated with higher mortality (OR, 1.45; p < 0.05), morbidity (OR, 1.66; p < 0.001), longer length of stay (mean difference, 3.65 days; p < 0.001), and higher hospital charges by $31,497 (p< 0.001). Risk factors for ureteral injuries included rectal cancer (OR, 1.85), adhesions (OR, 1.83), metastatic cancer (OR, 1.76), weight loss/malnutrition (OR, 1.08), and teaching hospitals (OR, 1.05). Protective factors included the use of laparoscopy (OR, 0.91), transverse colectomy (OR, 0.90), and right colectomy (OR, 0.43).
This was a retrospective study from an administrative database.
Iatrogenic ureteral injuries are rare complications in colorectal surgery; however, their incidence appears to be rising. Ureteral injuries are associated with higher mortality, morbidity, hospital charge, and length of stay, and their incidence can be predicted by several factors.
结直肠外科手术中医源性输尿管损伤较为少见。目前对于其发病率、相关结局及易患因素所知甚少。
本研究旨在探讨美国十年来医源性输尿管损伤的趋势及其结局和危险因素。
本研究为回顾性研究。
分析了 2001 年至 2010 年全国住院患者样本。
包括接受结直肠手术的结直肠癌、良性息肉、憩室疾病或炎症性肠病患者。
在 10 年期间，研究了发生在结肠和直肠手术中的医源性输尿管损伤的趋势。通过多变量分析，分析了与输尿管损伤相关的死亡率、发病率、住院时间和总费用。最后，使用患者、医院和手术变量建立了输尿管损伤的预测模型。
在研究期间，美国估计有 2165848 例结直肠手术，共发现 6027 例输尿管损伤（0.28%）。与前五年（2001-2005 年）相比，后五年（2006-2010 年）输尿管损伤的发生率更高（3.1/1000 比 2.5/1000；p<0.001）。输尿管损伤与较高的死亡率（OR，1.45；p<0.05）、发病率（OR，1.66；p<0.001）、更长的住院时间（平均差异 3.65 天；p<0.001）和更高的医院费用（$31497；p<0.001）独立相关。输尿管损伤的危险因素包括直肠癌（OR，1.85）、粘连（OR，1.83）、转移性癌症（OR，1.76）、体重减轻/营养不良（OR，1.08）和教学医院（OR，1.05）。保护因素包括腹腔镜（OR，0.91）、横结肠切除术（OR，0.90）和右半结肠切除术（OR，0.43）。
这是一项来自行政数据库的回顾性研究。
医源性输尿管损伤是结直肠外科手术中罕见的并发症；然而，其发生率似乎正在上升。输尿管损伤与较高的死亡率、发病率、医院费用和住院时间相关，其发生率可由多个因素预测。
