Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA.
Queen's University School of Medicine, Kingston, Canada.
J Gastrointest Surg. 2019 Oct;23(10):2019-2026. doi: 10.1007/s11605-018-4001-9. Epub 2018 Oct 22.
An area of contention among colorectal surgeons is when it is safe to discharge patients who have undergone closure of diverting ostomies. This study aimed to review the trends in outpatient stoma closure (OSC), to assess the safety of this practice, and to identify appropriate surgical candidates for the outpatient procedure.
Patients were queried from the ACS National Surgical Quality Improvement Program database (2005-2016). Main outcomes included Clavien-Dindo (C-D) III-V class surgical complications, and readmission. Outpatient stay was defined as a hospital stay of less than or equal to 1 day. Multivariable logistic regression analysis was used to identify risk factors for C-D III-V complications and readmission.
Of 24,393 patients, 668 (2.74%) underwent an OSC. OSC has increased over the last decade (3.16% 2005-2006, 4.14% 2016, p < 0.001). Outpatients had significantly lower ASA class and fewer comorbidities than inpatients. Outpatient complication rate was significantly lower than the inpatient rate (2.99% vs. 7.25%, p < 0.001). Readmissions were comparable (8.92% outpatient vs. 9.77% inpatient, p = 0.54). ASA > 2, smoking, COPD, dyspnea, steroid use, bleeding disorder, and partial/total dependency were associated with increased risk of complications and readmission. Patients without any risk factors had lower complication (4.75%) and readmission rates (8.09%) compared to those with ≥ 2 risk factors (11.50% complication and 13.07% readmission rate, p < 0.001).
There is an increasing trend in the percentage of stoma closures being performed as outpatient procedures. Appropriate selection of patients preoperatively who are suitable candidates for OSC can be helpful in managing patient expectations and hospital resources.
在结肠直肠外科医生中，何时可以安全地为接受转流造口关闭的患者出院是一个有争议的问题。本研究旨在回顾门诊造口关闭（OSC）的趋势，评估该操作的安全性，并确定门诊手术的合适手术候选人。
从 ACS 国家手术质量改进计划数据库（2005-2016 年）中查询患者。主要结果包括 Clavien-Dindo（C-D）III-V 级手术并发症和再入院。门诊住院定义为住院时间少于或等于 1 天。多变量逻辑回归分析用于确定 C-D III-V 并发症和再入院的危险因素。
在 24393 名患者中，有 668 名（2.74%）接受了 OSC。在过去十年中，OSC 的比例有所增加（2005-2006 年为 3.16%，2016 年为 4.14%，p<0.001）。门诊患者的 ASA 分级和合并症明显低于住院患者。门诊并发症发生率明显低于住院患者（2.99%对 7.25%，p<0.001）。再入院率相似（8.92%门诊 vs. 9.77%住院，p=0.54）。ASA>2、吸烟、COPD、呼吸困难、皮质类固醇使用、出血性疾病和部分/全部依赖与并发症和再入院风险增加相关。无任何危险因素的患者并发症发生率（4.75%）和再入院率（8.09%）低于有≥2 个危险因素的患者（11.50%并发症和 13.07%再入院率，p<0.001）。
门诊进行造口关闭的比例呈上升趋势。术前适当选择适合 OSC 的患者，可以帮助管理患者的期望和医院资源。
