Diamond Shawn, Moghaddas Hassan S, Kaminski Stephen S, Grotts Jonathan, Ferrigno Lisa, Schooler Wesley
Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
Am Surg. 2016 Oct;82(10):903-906.
Over two million Americans receive treatment for pressure ulcers (PUs) annually, but national surgical outcomes are not well described. This study investigated rates and risk factors of postoperative complications in patients with PU. The 2011 and 2012 American College of Surgeons-National Surgical Quality Improvement Project database was queried and PU patients undergoing flap closure were identified. Descriptive statistics and multivariate regression analysis was used and reported as odds ratios (ORs) if (P < 0.05). Of 1196 patients identified with a primary diagnosis of PU, 327 (27%) underwent flap closure. Emergency interventions were performed in seven patients who were excluded from analysis. Characteristics were average age 53.3 (±17); 65 per cent male; 41 per cent with grossly contaminated or infected wounds; 29 per cent frail; and 16 per cent with an American Society of Anesthesiologists score of four or five. Myocutaneous or fasciocutaneous flaps were performed in 82 per cent of patients, local skin rearrangements in 17 per cent, and free flap in one patient. Complications were low with 1.9 per cent recurrence and 4.7 per cent reoperation rates. Higher American Society of Anesthesiologists was independently associated with mortality (odds ratio = 6.6) and steroid use correlated with flap failure (odds ratio = 15). No differences in complication profiles were identified based on technique, frailty, or contamination. Surgical closure can be considered reasonable in all patients fit for anesthesia.
每年有超过200万美国人接受压疮（PU）治疗，但全国性的手术治疗效果尚无详尽描述。本研究调查了PU患者术后并发症的发生率及危险因素。查询了2011年和2012年美国外科医师学会-国家外科质量改进项目数据库，识别出接受皮瓣闭合术的PU患者。采用描述性统计和多变量回归分析，若P<0.05，则以比值比（OR）报告结果。在1196例初步诊断为PU的患者中，327例（27%）接受了皮瓣闭合术。7例接受急诊干预的患者被排除在分析之外。患者特征为平均年龄53.3岁（±17）；65%为男性；41%的伤口严重污染或感染；29%身体虚弱；16%的美国麻醉医师协会评分为4或5分。82%的患者采用肌皮瓣或筋膜皮瓣，17%采用局部皮肤重新排列，1例采用游离皮瓣。并发症发生率较低，复发率为1.9%，再次手术率为4.7%。美国麻醉医师协会评分较高与死亡率独立相关（比值比=6.6），使用类固醇与皮瓣失败相关（比值比=15）。根据手术技术、身体虚弱程度或伤口污染情况，未发现并发症情况存在差异。对于所有适合麻醉的患者，手术闭合可被认为是合理的。
