优化合并行皮瓣切除术的腹疝修补术患者选择：来自 ACS-NSQIP 数据集的 1974 例患者分析。

Optimizing patient selection in ventral hernia repair with concurrent panniculectomy: an analysis of 1974 patients from the ACS-NSQIP datasets.

机构信息

Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

出版信息

J Plast Reconstr Aesthet Surg. 2014 Nov;67(11):1532-40. doi: 10.1016/j.bjps.2014.07.001. Epub 2014 Jul 12.

DOI:10.1016/j.bjps.2014.07.001

PMID:25085825

Abstract

BACKGROUND

Panniculectomy (PAN) during ventral hernia repair (VHR) can be a challenging procedure associated with added risk. We utilized the ACS-NSQIP datasets to generate a risk model of morbidity following these combined interventions.

METHODS

The 2005-2012 ACS-NSQIP databases were queried to identify all patients undergoing VHR-PAN. Multivariate logistic regression analyses were used to assess perioperative factors associated with surgical and medical morbidity. Internal validation was performed using bootstrap analysis and risk stratification was performed using weighted β-coefficients.

RESULTS

1974 patients underwent VHR-PAN with an average age of 53.6 ± 12.4 years and BMI of 36.4 ± 10.1 kg/m2. Surgical complications occurred in 23.8% of patients, whereas medical complications occurred in 11.5%. A multivariate logistic regression identified the presence of a renal comorbidity (OR = 1.62, P = 0.045), class II obesity (BMI = 34.9-40.0 kg/m2) (OR = 1.89, P < 0.001), class III obesity (BMI≥40 kg/m2) (OR = 2.66, P < 0.001), dirty/infected wound class (OR = 2.01, P = 0.003), smoking (OR = 1.41, P = 0.026), prolonged operative time (OR = 2.12, P = 0.001), and ASA physical status of ≥3 (OR = 1.69, P < 0.001) as independently associated with higher incidences of postoperative surgical complications. A multivariate regression analysis identified class II or III obesity (OR = 1.70, P = 0.003), contaminated or dirty/infected wounds (OR = 1.95, P < 0.001), diabetes (OR = 1.96, P = 0.001), pulmonary comorbidity (OR = 2.08, P = 0.005), and component separation (OR = 2.65, P < 0.001) as independently associated with higher incidences of postoperative medical complications. Simplified risk models of surgical and medical morbidity demonstrated good discrimination with C statistics of 0.69 and 0.70, respectively.

CONCLUSIONS

We report a simple preoperative, internally-validated risk model of surgical and medical morbidity following VHR-PAN to guide patient selection.

LEVEL OF EVIDENCE

Prognostic/risk category, level II.

摘要

背景

腹疝修补术（VHR）期间的 panniculectomy（PAN）可能是一种具有附加风险的具有挑战性的手术。我们利用 ACS-NSQIP 数据集生成了这些联合干预措施后发病率的风险模型。

方法

查询 2005-2012 年 ACS-NSQIP 数据库，以确定所有接受 VHR-PAN 的患者。多变量逻辑回归分析用于评估与手术和医疗发病率相关的围手术期因素。内部验证使用引导分析进行，风险分层使用加权β系数进行。

结果

1974 例患者接受了 VHR-PAN，平均年龄为 53.6±12.4 岁，BMI 为 36.4±10.1kg/m2。23.8%的患者发生手术并发症，11.5%发生医疗并发症。多变量逻辑回归确定存在肾功能合并症（OR=1.62，P=0.045）、II 类肥胖（BMI=34.9-40.0kg/m2）（OR=1.89，P＜0.001）、III 类肥胖（BMI≥40kg/m2）（OR=2.66，P＜0.001）、污染/感染伤口等级（OR=2.01，P=0.003）、吸烟（OR=1.41，P=0.026）、手术时间延长（OR=2.12，P=0.001）和 ASA 身体状况≥3（OR=1.69，P＜0.001）与术后手术并发症发生率较高独立相关。多变量回归分析确定 II 类或 III 类肥胖（OR=1.70，P=0.003）、污染或感染伤口（OR=1.95，P＜0.001）、糖尿病（OR=1.96，P=0.001）、肺部合并症（OR=2.08，P=0.005）和组件分离（OR=2.65，P＜0.001）与术后医疗并发症发生率较高独立相关。手术和医疗发病率的简化风险模型显示出良好的区分度，C 统计分别为 0.69 和 0.70。