Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
J Am Coll Surg. 2014 Jun;218(6):1105-12. doi: 10.1016/j.jamcollsurg.2014.01.054. Epub 2014 Feb 28.
Paracolostomy hernia repair (PHR) can be a challenging procedure associated with significant morbidity and high recurrence rates. We sought to analyze the complication rate and 30-day mortality among patients undergoing PHR.
This is a retrospective analysis of patients with PHR, based on Current Procedural Terminology code 44346, using the NSQIP database from 2005 to 2008. Univariate analysis of 30-day outcomes after both emergent and nonemergent PHR in patients greater than or less than 70 years old was completed.
There were 519 patients who underwent PHR (mean age, 63.9 years old, female, 55.9%). Emergency PHR, performed in 59 patients (11.4%), was associated with increased rates of organ space surgical site infection (SSI) (8.5% vs 0.9%, p = 0.0014), pneumonia (18.6% vs 2.6%, p ≤ 0.0001), septic shock (13.6% vs 2.6%, p = 0.0007), total morbidity (50.8% vs 2.6%, p ≤ 0.0001), and death (10.2% vs 0.9%; p = 0.0002). In patients older than 70 years, emergent PHR amplified these differences: organ space SSI (13.8% vs 1.2%, p = 0.0054); pneumonia (27.6% vs 3.7%; p = 0.0002), septic shock (17.2% vs 4.3%; p = 0.02), and mortality (20.7% vs 1.9%; p = 0.0005).
This study revealed that most PHRs are performed electively. Although elective repair remains a relatively safe procedure, even in the elderly, emergency PHR is associated with increased morbidity, especially pulmonary and septic complications, and higher mortality. These results are amplified among patients older than 70 years undergoing emergent repair. These findings suggest that greater consideration should be given to elective repair of paracolostomy hernias in the elderly because emergency repair is associated with considerable risk and worse outcomes.
侧结肠造口疝修补术（PHR）是一种具有挑战性的手术，其相关并发症发生率较高，复发率也较高。我们旨在分析行 PHR 患者的并发症发生率和 30 天死亡率。
这是一项基于 2005 年至 2008 年 NSQIP 数据库，采用当前操作术语代码 44346 对行 PHR 的患者进行的回顾性分析。对年龄大于或小于 70 岁的紧急和非紧急 PHR 患者的 30 天结局进行了单变量分析。
共 519 例行 PHR 患者（平均年龄 63.9 岁，女性 55.9%）。59 例（11.4%）行紧急 PHR，其发生器官间隙手术部位感染（SSI）的风险增加（8.5% vs 0.9%，p=0.0014）、肺炎（18.6% vs 2.6%，p≤0.0001）、感染性休克（13.6% vs 2.6%，p=0.0007）、总发病率（50.8% vs 2.6%，p≤0.0001）和死亡率（10.2% vs 0.9%，p=0.0002）。在年龄大于 70 岁的患者中，紧急 PHR 放大了这些差异：器官间隙 SSI（13.8% vs 1.2%，p=0.0054）、肺炎（27.6% vs 3.7%，p=0.0002）、感染性休克（17.2% vs 4.3%，p=0.02）和死亡率（20.7% vs 1.9%，p=0.0005）。
本研究表明，大多数 PHR 是择期进行的。虽然择期修复仍然是一种相对安全的手术，但即使在老年人中，紧急 PHR 也与更高的发病率相关，特别是肺部和感染性并发症以及更高的死亡率相关。这些结果在年龄大于 70 岁且行紧急修复的患者中被放大。这些结果表明，对于老年患者的侧结肠造口疝，应更倾向于选择择期修复，因为紧急修复风险较高，预后较差。
