Amini Neda, Margonis Georgios A, Kim Yuhree, Wilson Ana, Gani Faiz, Pawlik Timothy M
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
J Surg Res. 2016 Jun 15;203(2):495-506. doi: 10.1016/j.jss.2016.04.047. Epub 2016 Apr 27.
To date, no study has specifically focused on the timing of complications after hepatectomy relative to patient outcomes. We sought to investigate the effect of complication timing on 30-d mortality.
A total of 3064 patients who underwent hepatic resection in 2014 were identified from American College of Surgeons National Surgical Quality Improvement Program database. Cox regression analysis was performed to determine the association of complication timing with 30-d mortality.
Median patient age was 60 y (interquartile range, 50-68). Among all patients who experienced a complication, 16.6% had only a postdischarge complication. Wound disruption (64%) and surgical site infection (58.1%) occurred frequently after discharge. Organ space surgical site infection occurred at a later time after surgery among patients who underwent minimally invasive surgery (minimally invasive surgery, 16 d versus open 10 d; P = 0.008). Among 47 (1.5%) patients who died within 30 d from surgery, 21.3% of deaths occurred postdischarge. After adjusting for competing risk factors, patients who had experienced a postdischarge complication demonstrated an increased risk of 30-d mortality (referent, predischarge, hazard ratio 2.96, 95% confidence intervals 1.07-8.17; P = 0.04).
Postdischarge complications occurred less frequently after hepatectomy than predischarge complications; however, late complications were associated with a three-fold increased risk of mortality.
迄今为止，尚无研究专门关注肝切除术后并发症发生时间与患者预后的关系。我们旨在研究并发症发生时间对30天死亡率的影响。
从美国外科医师学会国家外科质量改进计划数据库中识别出2014年接受肝切除的3064例患者。进行Cox回归分析以确定并发症发生时间与30天死亡率之间的关联。
患者中位年龄为60岁（四分位间距，50 - 68岁）。在所有发生并发症的患者中，16.6%仅发生出院后并发症。伤口裂开（64%）和手术部位感染（58.1%）在出院后频繁发生。接受微创手术的患者术后发生器官腔隙手术部位感染的时间较晚（微创手术，16天对开放手术10天；P = 0.008）。在术后30天内死亡的47例（1.5%）患者中，21.3%的死亡发生在出院后。在对竞争风险因素进行校正后，发生出院后并发症的患者30天死亡率风险增加（参照，出院前，风险比2.96，95%置信区间1.07 - 8.17；P = 0.04）。
肝切除术后出院后并发症的发生率低于出院前并发症；然而，晚期并发症与死亡率增加三倍相关。
