Cologne Kyle G, Byers Sean, Rosen David R, Hwang Grace S, Ortega Adrian E, Ault Glenn T, Lee Sang W
Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Am Surg. 2016 Oct;82(10):960-963.
A prospectively maintained database of 415 patients undergoing colectomy was evaluated. We performed a logistic regression analysis to identify factors associated with 1) length of stay (LOS) of 2 days or less and 2) LOS of 10 days or more. Investigated variables included demographics, American Society of Anesthesiology (ASA) score, diagnosis, operative procedure, approach and time, transfusion requirements, and occurrence of any complications. Factors associated with a LOS of two days or less included ASA [odds ratio (OR): 0.34, 95% confidence interval (CI): 0.208-0.576], use of transversus abdominis plane block (OR: 5.259, 95% CI: 2.825-9.791), and operative time (OR: 0.98, 95% CI: 0.974-0.986). Age >65 had an OR of 1.73, though this did not reach statistical significance. Factors associated with LOS >10 days included ASA (OR: 2.152, 95% CI: 1.245-3.721), anastomotic leak (OR: 2.163, 95% CI: 1.486-3.148), ileus (OR: 8.790, 95% CI: 4.501-17.165), and surgical site infection (OR: 5.846, 95% CI: 2.764-12.362). Cancer and transfusion status were associated but did not reach statistical significance. Although operative time was longer in left-sided resections, no differences in LOS were observed. In conclusion, numerous factors are associated with short or long LOS and may help stratify resource utilization after colectomy. Further study is needed to confirm our findings.
对一个前瞻性维护的、包含415例行结肠切除术患者的数据库进行了评估。我们进行了逻辑回归分析,以确定与以下因素相关的因素:1)住院时间(LOS)为2天或更短;2)LOS为10天或更长。研究变量包括人口统计学、美国麻醉医师协会(ASA)评分、诊断、手术操作、入路和时间、输血需求以及任何并发症的发生情况。与LOS为2天或更短相关的因素包括ASA[比值比(OR):0.34,95%置信区间(CI):0.208 - 0.576]、腹横肌平面阻滞的使用(OR:5.259,95% CI:2.825 - 9.791)以及手术时间(OR:0.98,95% CI:0.974 - 0.986)。年龄>65岁的OR为1.73,尽管这未达到统计学显著性。与LOS>10天相关的因素包括ASA(OR:2.152,95% CI:1.245 - 3.721)、吻合口漏(OR:2.163,95% CI:1.486 - 3.148)、肠梗阻(OR:8.790,95% CI:4.501 - 17.165)以及手术部位感染(OR:5.846,95% CI:2.764 - 12.362)。癌症和输血状态相关,但未达到统计学显著性。尽管左侧切除术的手术时间较长,但未观察到LOS的差异。总之,许多因素与短或长的LOS相关,可能有助于对结肠切除术后的资源利用进行分层。需要进一步研究来证实我们的发现。