Jeppesen Maja Haunstrup, Tolstrup Mai-Britt, Kehlet Watt Sara, Gögenur Ismail
Department of Gastroenterology, Surgical Section, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark; Department of Surgery, Zealand University Hospital Køge, Lykkebæksvej 1, 4600 Koege, Denmark.
Department of Gastroenterology, Surgical Section, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
Int J Surg. 2016 Apr;28:63-8. doi: 10.1016/j.ijsu.2016.02.059. Epub 2016 Feb 18.
To identify risk factors for increased 30-day morbidity and mortality, using standardized measuring tools for the characterization of complications after emergency surgery for small bowel obstruction.
A retrospective cohort study including patients treated with emergency laparotomy for small bowel obstruction at a Copenhagen University Hospital (2009-2013). Complications were evaluated according to the Clavien-Dindo classification.
A total of 323 patients were included. The overall 30-day morbidity and mortality rates were 28% and 13%, respectively. Six covariates were identified as independent risk factors associated with morbidity by multiple logistic regression analysis. The highest odds for morbidity were seen in patients with chronic nephropathy (Odds Ratio [OR] = 3.9; 95% CI 1.3-15.1), and in patients with a daily use of steroids (OR = 3.5; 95% CI 1.2-10.4). Five independent risk factors were associated with increased odds for mortality. Patients with low physical performance (OR = 3.4; 95% CI 1.3-8.2) or metabolic disorders (OR = 3.2; 95% CI 1.2-8.5) had the highest risk of mortality.
Morbidity and mortality rates were high in this study compared with other studies. Several comorbid conditions were associated with morbidity and mortality. These results may aid the acute care surgeon in identifying patients with a high-risk for postoperative complications and fatal outcomes.
使用标准化测量工具来确定小肠梗阻急诊手术后并发症特征，以识别30天发病率和死亡率增加的风险因素。
一项回顾性队列研究，纳入了哥本哈根大学医院（2009 - 2013年）接受小肠梗阻急诊剖腹手术的患者。根据Clavien - Dindo分类法评估并发症。
共纳入323例患者。30天总体发病率和死亡率分别为28%和13%。通过多因素逻辑回归分析确定了六个协变量为与发病率相关的独立风险因素。慢性肾病患者（比值比[OR]=3.9；95%置信区间1.3 - 15.1）和每日使用类固醇的患者（OR = 3.5；95%置信区间1.2 - 10.4）发病率最高。五个独立风险因素与死亡率增加的比值相关。身体机能低下（OR = 3.4；95%置信区间1.3 - 8.2）或代谢紊乱（OR = 3.2；95%置信区间1.2 - 8.5）的患者死亡率最高。
与其他研究相比，本研究中的发病率和死亡率较高。几种合并症与发病率和死亡率相关。这些结果可能有助于急性外科医生识别术后并发症和致命结局风险高的患者。
