Hassan Imran, Pacheco Paul E, Markwell Stephen J, Ahad Sajida
Department of Surgery, University of Iowa, Iowa City, IA, USA,
J Gastrointest Surg. 2015 Mar;19(3):527-34. doi: 10.1007/s11605-014-2711-1. Epub 2014 Dec 18.
The need for additional procedures during a segmental elective colectomy is considered to lead to increased postoperative morbidity, but there have been few data that have validated and quantified this risk.
We hypothesized that patients having additional procedures performed during a segmental colectomy have worse outcomes compared to patients undergoing a colectomy alone.
All patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent an elective open or laparoscopic segmental colectomy during 2005-2009 and met the inclusion criteria were analyzed. Using current procedural terminology (CPT) codes, patients were stratified into three groups. Group 1 only had CPT codes for a colectomy. Group 2 had additional CPT codes for procedures that were considered related to the colectomy, such as splenic flexure mobilization and endoscopy or a relatively minor procedure such as an appendectomy. Group 3 included patients that had additional procedures performed along with a segmental colectomy. Serious morbidity, overall morbidity, return to the operating room, and death were calculated and compared for each group.
There were 25,996 patients in the open and 20,396 patients in the laparoscopic colectomy group. Thirty-six percent of patients in the open colectomy group vs. 18 % in the laparoscopic colectomy group had additional procedures performed. After adjustment for available differences in the groups, patients undergoing open and laparoscopic segmental colectomy along with an additional procedure had worse postoperative outcomes compared to patients undergoing a colectomy alone.
The study is limited by the possibility of coding errors in the ACS NSQIP database leading to a case ascertainment bias and a selection bias given the observational nature of the study. It also could not differentiate between additional procedures that were planned or incidental at the time of surgery.
A proportion of patients undergoing elective open and laparoscopic segmental colon resections undergo additional procedures that adversely impact postoperative outcomes. This is mainly related to the type of additional procedures performed and therefore should be accounted for when counseling patients about the risks of surgery and in comparisons of outcomes.
在节段性择期结肠切除术中需要额外进行手术被认为会导致术后发病率增加，但很少有数据能证实并量化这种风险。
我们假设与仅接受结肠切除术的患者相比，在节段性结肠切除术中进行额外手术的患者预后更差。
对美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中2005 - 2009年间接受择期开放或腹腔镜节段性结肠切除术且符合纳入标准的所有患者进行分析。使用当前程序术语（CPT）编码，将患者分为三组。第1组仅有结肠切除术的CPT编码。第2组有与结肠切除术相关的额外CPT编码，如脾曲游离和内镜检查，或诸如阑尾切除术等相对较小的手术。第3组包括在节段性结肠切除术同时进行额外手术的患者。计算并比较每组的严重发病率、总体发病率、返回手术室情况及死亡率。
开放手术组有25996例患者，腹腔镜结肠切除术组有20396例患者。开放结肠切除术组36%的患者进行了额外手术，而腹腔镜结肠切除术组这一比例为18%。在对组间可用差异进行调整后，与仅接受结肠切除术的患者相比，接受开放和腹腔镜节段性结肠切除术并同时进行额外手术的患者术后预后更差。
该研究受到ACS NSQIP数据库中编码错误导致病例确定偏倚的可能性以及研究的观察性质所带来的选择偏倚的限制。它也无法区分手术时计划的额外手术和偶然进行的额外手术。
一部分接受择期开放和腹腔镜节段性结肠切除术的患者会进行额外手术，这些手术会对术后结果产生不利影响。这主要与所进行的额外手术类型有关，因此在向患者咨询手术风险以及比较结果时应予以考虑。
