滑结并发症分级预测右半结肠切除术后的短期结局。

Accordion complication grading predicts short-term outcome after right colectomy.

机构信息

Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.

Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

出版信息

J Surg Res. 2014 Aug;190(2):510-6. doi: 10.1016/j.jss.2013.11.1084. Epub 2013 Nov 19.

DOI:10.1016/j.jss.2013.11.1084

PMID:24485152

Abstract

BACKGROUND

The Accordion severity grading system is a novel system to score the severity of postoperative complications in a standardized fashion. This study aims to demonstrate the validity of the Accordion system in colorectal surgery by correlating severity grades with short-term outcomes after right colectomy for colon cancer.

METHODS

This is a retrospective cohort review of patients who underwent right colectomy for cancer between January 1, 2002, and January 31, 2007, at a single tertiary care referral center. Complications were categorized according to the Accordion severity grading system: grades 1 (mild), 2 (moderate), 3-5 (severe), and 6 (death). Outcome measures were hospital stay, 30-d readmission rate and 1-y survival. Correlation between Accordion grades and outcome measures is reflected by Spearman rho (ρ). One-year survival was obtained per Kaplan-Meier method and compared by logrank test for trend. Significance was set at P ≤ 0.05.

RESULTS

Overall, 235 patients underwent right colectomy for cancer of which 122 (51.9%) had complications. In total, 52 (43%) had an Accordion grade 1 complication; 44 (36%) grade 2; four (3%) grade 3; 11 (9%) grade 4; seven (6%) grade 5; and four (3%) grade 6. There was significant correlation between Accordion grades and hospital stay (ρ = 0.495, P < 0.001) and 30-d readmission rate (ρ = 0.335, P < 0.001). There was a significant downward trend in 1-y survival as complication severity by Accordion grade increased (P = 0.02).

CONCLUSIONS

The Accordion grading system is a useful tool to estimate short-term outcomes after right colectomy for cancer. High-grade Accordion complications are associated with longer hospital stay and increased risk of readmission and mortality.

摘要

背景

Accordion 严重程度分级系统是一种新颖的评分系统，用于标准化地评估术后并发症的严重程度。本研究旨在通过将严重程度分级与右半结肠癌根治术后的短期结果相关联，来证明 Accordion 系统在结直肠手术中的有效性。

方法

这是一项回顾性队列研究，纳入了 2002 年 1 月 1 日至 2007 年 1 月 31 日期间在一家三级转诊中心接受右半结肠癌根治术的患者。并发症根据 Accordion 严重程度分级系统进行分类：1 级（轻度）、2 级（中度）、3-5 级（重度）和 6 级（死亡）。观察指标为住院时间、30 天再入院率和 1 年生存率。Accordion 分级与观察指标之间的相关性通过 Spearman rho（ρ）反映。通过 Kaplan-Meier 法获得 1 年生存率，并通过对数秩检验进行趋势比较。P 值≤0.05 为差异有统计学意义。

结果

共有 235 例患者接受了右半结肠癌根治术，其中 122 例（51.9%）发生了并发症。总共 52 例（43%）患者的 Accordion 分级为 1 级并发症；44 例（36%）为 2 级；4 例（3%）为 3 级；11 例（9%）为 4 级；7 例（6%）为 5 级；4 例（3%）为 6 级。Accordion 分级与住院时间（ρ=0.495，P<0.001）和 30 天再入院率（ρ=0.335，P<0.001）之间存在显著相关性。随着 Accordion 分级增加，1 年生存率呈显著下降趋势（P=0.02）。