腹水对充血性心力衰竭患者结直肠手术预后的影响。

Effects of ascites on outcomes of colorectal surgery in congestive heart failure patients.

作者信息

Moghadamyeghaneh Zhobin, Carmichael Joseph C, Mills Steven D, Pigazzi Alessio, Stamos Michael J

机构信息

Department of Surgery, School of Medicine, University of California, Irvine, 333 City Boulevard West, Suite 1600, Orange, CA, USA.

出版信息

Am J Surg. 2015 Jun;209(6):1020-7. doi: 10.1016/j.amjsurg.2014.08.021. Epub 2014 Oct 13.

DOI:10.1016/j.amjsurg.2014.08.021

PMID:25457249

Abstract

BACKGROUND

There are limited data regarding the effects of ascites on outcome of patients undergoing colorectal resection. We sought to identify complications related to ascites.

METHODS

The National Surgical Quality Improvement Program database was used to evaluate congestive heart failure (CHF) patients who had ascites before colorectal resection between 2005 and 2012. Multivariate regression analysis was performed to identify affected outcomes.

RESULTS

We sampled a total of 2,178 patients who suffered CHF and underwent colorectal resection, of which 195 (9%) had preoperative ascites. The mortality rate of patients who had preoperative ascites was 46.2% compared to 25.7% for patients without ascites (adjusted odd ratio [AOR], 3.38; P < .01). Complications affected by ascites include (P < .05) ventilator dependency (AOR, 2.40), acute renal failure (AOR, 2.18), and wound disruption (AOR, 2.44; P < .05). There was no increase in superficial surgical site infection rate in patients with ascites (AOR, 1.01; P = .9).

CONCLUSIONS

The presence of ascites in CHF patients is associated with increased mortality in patients undergoing colorectal surgery. There is no correlation between ascites and surgical site infection but wound disruption increases in the presence of ascites.

摘要

背景

关于腹水对接受结直肠切除术患者预后的影响，相关数据有限。我们试图确定与腹水相关的并发症。

方法

利用国家外科质量改进计划数据库评估2005年至2012年间在结直肠切除术前患有腹水的充血性心力衰竭（CHF）患者。进行多变量回归分析以确定受影响的预后。

结果

我们共抽取了2178例患有CHF并接受结直肠切除术的患者，其中195例（9%）术前有腹水。术前有腹水患者的死亡率为46.2%，而无腹水患者为25.7%（校正比值比[AOR]，3.38；P <.01）。受腹水影响的并发症包括（P <.05）呼吸机依赖（AOR，2.40）、急性肾衰竭（AOR，2.18）和伤口裂开（AOR，2.44；P <.05）。腹水患者的浅表手术部位感染率没有增加（AOR，1.01；P =.9）。