Okumura K, Hida K, Kunisawa S, Nishigori T, Hosogi H, Sakai Y, Imanaka Y
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
World J Surg. 2018 Mar;42(3):758-765. doi: 10.1007/s00268-017-4211-4.
Many perforated peptic ulcers (PPUs) require surgical repair due to diffuse peritonitis. However, few studies have examined the clinical effects of postoperative drainage after PPU repair. This study aimed to investigate the drain insertion rates in patients who underwent PPU repair in Japan, and to clarify the impact of drain insertion on the postoperative clinical course.
A retrospective nationwide cohort study was performed using administrative claims data of patients who had undergone PPU repair between 2010 and 2016. These patients were divided into two groups based on whether or not they had received a postoperative abdominal drain. Using propensity score matching, we compared the incidences of postoperative interventions for abdominal complications between both groups.
A total of 4869 patients from 324 hospitals were analyzed. At the hospital level, drains were placed in all PPU repair patients in 229 (70.7%) hospitals. At the patient level, 4401 patients (90.4%) had drains inserted. The drain group was associated with a higher emergency admission rate, poorer preoperative shock status, longer anesthetic time, and a higher amount of intra-abdominal irrigation. In the propensity score-matched patients, the drain group had a significantly lower incidence of postoperative interventions than the no-drain group (1.9 vs. 5.6%; risk ratio = 0.35; 95% confidence interval 0.16-0.73; P = 0.003).
Postoperative drainage was performed in the majority of patients who underwent PPU repair in Japan. Drainage following PPU repair may facilitate patient recovery by reducing the need for postoperative interventions.
许多穿孔性消化性溃疡（PPU）因弥漫性腹膜炎需要手术修复。然而，很少有研究探讨PPU修复术后引流的临床效果。本研究旨在调查日本接受PPU修复患者的引流管插入率，并阐明引流管插入对术后临床过程的影响。
利用2010年至2016年间接受PPU修复患者的行政索赔数据进行一项全国性回顾性队列研究。根据患者术后是否放置腹腔引流管将其分为两组。采用倾向评分匹配法，比较两组腹部并发症术后干预的发生率。
共分析了来自324家医院的4869例患者。在医院层面，229家（70.7%）医院对所有PPU修复患者均放置了引流管。在患者层面，4401例患者（90.4%）插入了引流管。引流组的急诊入院率更高、术前休克状态更差、麻醉时间更长、腹腔冲洗量更多。在倾向评分匹配的患者中，引流组术后干预的发生率显著低于无引流组（1.9%对5.6%；风险比=0.35；95%置信区间0.16 - 0.73；P = 0.003）。
在日本，大多数接受PPU修复的患者进行了术后引流。PPU修复术后引流可能通过减少术后干预需求促进患者康复。
