Li Linda, Lau Kelsey S, Ramanathan Venkat, Orcutt Sonia T, Sansgiry Shubhada, Albo Daniel, Berger David H, Anaya Daniel A
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Department of Medicine, Baylor College of Medicine, Houston, Texas.
J Surg Res. 2017 Apr;210:204-212. doi: 10.1016/j.jss.2016.11.039. Epub 2016 Nov 29.
Ileostomy creation is associated with postoperative dehydration and readmission; however, the effect on renal function is unknown. Our goal was to characterize the impact of ileostomy creation on acute and chronic renal function.
A retrospective cohort study with patients undergoing colorectal cancer surgery at a tertiary referral institution (2005-2011). The relationship between ileostomy creation and acute kidney injury (AKI)-related readmission, severe chronic kidney disease (CKD) at 12 mo (glomerular filtration rate <30 mL/min/1.73 m), and onset of severe CKD over time was evaluated using multivariable logistic and Cox regression and adjusted using propensity score stratification.
Among 619 patients, 84 (13%) had ileostomy. AKI-related readmission and severe CKD at 12 mo were more common among ileostomy patients (17% versus 2%, P < 0.01 and 13.3% versus 5%, P = 0.02, respectively). After propensity score adjustment, ileostomy was a significant predictor of AKI-related readmissions (odds ratio: 10.3; 95% confidence interval [CI], 3.9-27.2), severe CKD at 12 mo (odds ratio: 4.1; 95% CI, 1.4-11.9), and onset of severe CKD over time (hazard ratio: 4.2; 95% CI, 2.3-6.6).
Ileostomy creation is associated with increased risk of AKI-related readmissions and development of severe CKD. Future studies must focus on strategies to minimize kidney injury when ileostomy is a necessary component of colorectal cancer surgery and revisiting current indications for ileostomy creation.
回肠造口术的实施与术后脱水及再次入院有关；然而，其对肾功能的影响尚不清楚。我们的目标是明确回肠造口术对急性和慢性肾功能的影响。
一项对在一家三级转诊机构接受结直肠癌手术的患者进行的回顾性队列研究（2005 - 2011年）。使用多变量逻辑回归和Cox回归评估回肠造口术与急性肾损伤（AKI）相关再次入院、12个月时的严重慢性肾脏病（CKD，肾小球滤过率<30 mL/min/1.73 m²）以及严重CKD随时间的发生情况之间的关系，并采用倾向评分分层进行调整。
在619例患者中，84例（13%）接受了回肠造口术。AKI相关再次入院和12个月时的严重CKD在回肠造口术患者中更为常见（分别为17%对2%，P<0.01；13.3%对5%，P = 0.02）。经过倾向评分调整后，回肠造口术是AKI相关再次入院（比值比：10.3；95%置信区间[CI]，3.9 - 27.2）、12个月时严重CKD（比值比：4.1；95%CI，1.4 - 11.9）以及严重CKD随时间发生情况（风险比：4.2；95%CI，2.3 - 6.6）的显著预测因素。
回肠造口术的实施与AKI相关再次入院风险增加及严重CKD的发生有关。未来的研究必须聚焦于在回肠造口术作为结直肠癌手术必要组成部分时将肾损伤降至最低的策略，以及重新审视当前回肠造口术的适应证。
