Coakley Kathleen M, Kasten Kevin R, Sims Stephanie M, Prasad Tanushree, Heniford B Todd, Davis Bradley R
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
Dis Colon Rectum. 2018 Jan;61(1):84-88. doi: 10.1097/DCR.0000000000000976.
Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial.
The aim of this study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy.
This was a retrospective study.
The study was conducted at a single tertiary care center.
The colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2014 was queried.
The primary end point was the rate of 30-day ureteral injury after colectomy. Univariate and multivariate analyses determined factors associated with ureteral injury and urinary tract infection in patients undergoing colectomy.
A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified. Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120). Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement. On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25-0.81)).
This was a retrospective study using a clinical data set.
Here, prophylactic ureteral catheters were used in 4.9% of colectomies and most commonly for diverticulitis. On multivariate analysis, prophylactic catheter placement was associated with a lower rate of ureteral injury. Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement. See Video Abstract at http://links.lww.com/DCR/A482.
尽管技术和工艺有所改进，但在结肠切除术中使用预防性输尿管导管以避免医源性输尿管损伤仍存在争议。
本研究旨在评估结肠切除术预防性输尿管导管的疗效和成本。
这是一项回顾性研究。
该研究在一家三级医疗中心进行。
查询了2012年至2014年以结肠切除术为目标的美国外科医师学会国家外科质量改进计划数据库。
主要终点是结肠切除术后30天输尿管损伤率。单因素和多因素分析确定了结肠切除术患者输尿管损伤和尿路感染的相关因素。
共识别出51125例患者，平均年龄60.9±14.9岁，体重指数28.4±6.7kg/m；4.90%（n=2486）的结肠切除术使用了预防性导管，共识别出333例输尿管损伤（0.65%）。预防性输尿管导管最常用于憩室病（42.2%；n=1048），憩室病结肠切除术中损伤最常见（36.0%；n=120）。对结果的单因素分析显示，放置预防性输尿管导管的患者肠梗阻、伤口感染、尿路感染、因尿路感染再次入院、浅表部位感染和30天再次入院的发生率较高。多因素分析显示，放置预防性输尿管导管与较低的输尿管损伤率相关（OR=0.45（95%CI，0.25-0.81））。
这是一项使用临床数据集的回顾性研究。
本研究中，4.9%的结肠切除术使用了预防性输尿管导管，最常用于憩室炎。多因素分析显示，放置预防性导管与较低的输尿管损伤率相关。需要进一步研究以确定最可能从预防性输尿管支架置入中获益的患者群体。见视频摘要：http://links.lww.com/DCR/A482 。
