Kolbe Nina, Bakey Stephanie, Louwers Lisa, Blyden Dionne, Horst Mathilda, Falvo Anthony, Patton Joe, Rubinfeld Ilan
Department of Acute Care Surgery/Surgical Critical Care, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA,
J Gastrointest Surg. 2015 Jun;19(6):1086-92. doi: 10.1007/s11605-015-2815-2. Epub 2015 Apr 11.
Acute severe pancreatitis is one of the most common gastrointestinal reasons for admission to hospitals in the USA. Up to 20 % of these patients will progress to necrotizing pancreatitis requiring intervention. The aim of this study is to identify specific preoperative factors for the development of Clavien 4 complications and mortality in patients undergoing pancreatic necrosectomy.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files were reviewed from 2007 to 2012 to identify patients who underwent a pancreatic necrosectomy. Postoperative complications were stratified into Clavien 4 (ICU level complications) and Clavien 5 (mortality). Univariate and multivariate analyses were performed.
A total of 1156 patients underwent a pancreatic necrosectomy from 2007 to 2012. Overall, 42 % of patients experienced a Clavien 4 complication. Mortality rate was 9.5 %. Nonindependent functional status and ASA class were highly significant (p < 0.001) in univariate analysis. Frailty and emergency surgery status (p < 0.001), as well as increased blood urea nitrogen (BUN) and alkaline phosphatase and decreased albumin (p < 0.05) demonstrated independent significance of Clavien 4 complications and mortality in multivariate analysis.
This study identified specific preoperative variables that place patients at increased risk of Clavien 4 complications and mortality after necrosectomy. Identification of high-risk patients can aid in selection of appropriate treatment strategies and allow for informed preoperative discussion regarding surgical risk.
急性重症胰腺炎是美国医院最常见的胃肠道入院原因之一。这些患者中高达20%会进展为需要干预的坏死性胰腺炎。本研究的目的是确定接受胰腺坏死组织清除术患者发生Clavien 4级并发症和死亡的特定术前因素。
回顾2007年至2012年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）参与者使用档案，以确定接受胰腺坏死组织清除术的患者。术后并发症分为Clavien 4级（重症监护病房级并发症）和Clavien 5级（死亡）。进行单因素和多因素分析。
2007年至2012年共有1156例患者接受了胰腺坏死组织清除术。总体而言，42%的患者发生了Clavien 4级并发症。死亡率为9.5%。在单因素分析中，非独立功能状态和美国麻醉医师协会（ASA）分级具有高度显著性（p<0.001）。在多因素分析中，虚弱和急诊手术状态（p<0.001），以及血尿素氮（BUN）和碱性磷酸酶升高和白蛋白降低（p<0.05）显示出Clavien 4级并发症和死亡的独立显著性。
本研究确定了特定的术前变量，这些变量使患者在坏死组织清除术后发生Clavien 4级并发症和死亡的风险增加。识别高危患者有助于选择合适的治疗策略，并允许在术前就是否进行手术的风险进行知情讨论。
