Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Surgery. 2014 Feb;155(2):311-9. doi: 10.1016/j.surg.2013.08.014.
Abdominal wall reconstruction (AWR) poses a substantial operative challenge, often in the setting of multiple failed attempts at repair in high-risk patients. Our aim was to assess risk factors for major operative morbidity after AWR using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) patient database.
A review of the ACS-NSQIP database of outcomes from 2005 to 2010 was performed to identify patients undergoing AWR utilizing Current Procedural Terminology codes for ventral hernia repair and a concomitant component separation. Independent variables included patient demographics, medical comorbidities, and operative considerations. Major operative complication (deep wound infection, graft or prosthetic loss, or unplanned return to the operating room within 30 days) was used as our dependent variable. Stepwise, multivariate logistic regression was performed to evaluate patient risk factors influencing the occurrence of major operative complications.
We identified 1,706 patients with an average age of 55.9 ± 12.8 years with 30.1% undergoing concurrent intra-abdominal procedures and 57.1% undergoing mesh repair. Notable medical comorbidities included obesity (63.4%), smoking (24.9%), hypertension (53.1%), diabetes (19.9%), and anemia (22.6%). Average operative time was 211.7 ± 105.0 minutes. Regression analysis determined that prolonged operative time (odds ratio [OR], 2.7; P < .001) and American Society of Anesthesiologists >2 (OR, 1.8; P = .009) were positively associated, whereas advanced age (OR, 0.5; P = .005) was negatively associated with the occurrence of major operative complications.
Greater operative times and overall patient health are important prognostic factors for individuals undergoing AWR. The increased physiologic stress of a greater operative duration on patients who often have multiple comorbidities seems to play a significant role in predicting negative outcomes after AWR.
腹壁重建（AWR）是一项艰巨的手术挑战，尤其是在高危患者多次修复失败的情况下。我们的目的是使用美国外科医师学会-国家外科质量改进计划（ACS-NSQIP）患者数据库评估 AWR 后发生主要手术并发症的风险因素。
回顾了 2005 年至 2010 年 ACS-NSQIP 数据库中接受 AWR 的患者，使用腹部疝修补术和伴随的组件分离的当前操作术语（Current Procedural Terminology，CPT）代码。独立变量包括患者人口统计学、合并症和手术考虑因素。主要手术并发症（深部伤口感染、移植物或假体丢失或术后 30 天内计划返回手术室）作为我们的因变量。采用逐步多元逻辑回归评估影响主要手术并发症发生的患者风险因素。
我们确定了 1706 例平均年龄为 55.9 ± 12.8 岁的患者，其中 30.1%同时进行了腹腔内手术，57.1%进行了网片修补。值得注意的合并症包括肥胖症（63.4%）、吸烟（24.9%）、高血压（53.1%）、糖尿病（19.9%）和贫血（22.6%）。平均手术时间为 211.7 ± 105.0 分钟。回归分析确定，手术时间延长（比值比[OR]，2.7；P <.001）和美国麻醉医师协会评分 > 2（OR，1.8；P =.009）与主要手术并发症的发生呈正相关，而年龄较大（OR，0.5；P =.005）与主要手术并发症的发生呈负相关。
较长的手术时间和患者整体健康状况是接受 AWR 的个体的重要预后因素。对于经常患有多种合并症的患者来说，较长的手术时间增加了生理应激，似乎在预测 AWR 后不良结局方面发挥了重要作用。
