Haines Krista, Rust Clayton, Nguyen Benjamin Pham, Agarwal Suresh
Am Surg. 2018 Dec 1;84(12):1869-1875.
Two main procedures are performed on patients suffering from colonic perforation, diverting colostomy and primary tissue repair. We investigated patient race, ethnicity, and socioeconomic status (SES) that predicted surgical outcomes after blunt or penetrating trauma. A retrospective analysis was performed using data from the National Trauma Data Bank for three years (2013-2015). We identified patients who presented with primary colonic injury and subsequent colon operation (n = 5431). Operations were grouped into three classes: colostomy, ileostomy, and nonostomy. Multiple linear and logistic regressions were performed to assess how race and insurance status are associated with the primary outcome of interest (ostomy formation) and secondary outcomes such as length of stay, time spent in ICU, and surgical site infection. Neither race/ethnicity nor insurance status proved to be reliable predictors for the formation of an ostomy. Patients who received either a colostomy or ileostomy were likely to have longer stays (OR [odds ratio]: 5.28; 95% CI [confidence interval]: 3.88-6.69) (OR: 11.24; 95% CI: 8.53-13.95), more time spent in ICU (2.73; 1.70-3.76) (7.98; 6.10-9.87), and increased risk for surgical site infection (1.32; 1.03-1.68) (2.54; 1.71-3.78). Race/ethnicity and SES were not reliable predictors for surgical decision-making on the formation of an ostomy after blunt and penetrating colonic injury. However, the severity of the injury as calculated by Injury Severity Score and the number of abdominal injuries were both associated with higher rates of colostomy and ileostomy. These data suggest that surgical decision-making is dependent on perioperative patient presentation and, not on race, ethnicity, or SES.
对于患有结肠穿孔的患者，主要进行两种手术，即结肠造口术和原发组织修复术。我们调查了预测钝性或穿透性创伤后手术结果的患者种族、族裔和社会经济地位（SES）。利用国家创伤数据库三年（2013 - 2015年）的数据进行了回顾性分析。我们确定了出现原发性结肠损伤并随后接受结肠手术的患者（n = 5431）。手术分为三类：结肠造口术、回肠造口术和非造口术。进行了多项线性和逻辑回归分析，以评估种族和保险状况如何与感兴趣的主要结果（造口形成）以及诸如住院时间、在重症监护病房的时间和手术部位感染等次要结果相关联。种族/族裔和保险状况都未被证明是造口形成的可靠预测因素。接受结肠造口术或回肠造口术的患者住院时间可能更长（比值比[OR]：5.28；95%置信区间[CI]：3.88 - 6.69）（OR：11.24；95% CI：8.53 - 13.95），在重症监护病房的时间更多（2.73；1.70 - 3.76）（7.98；6.10 - 9.87），手术部位感染风险增加（1.32；1.03 - 1.68）（2.54；1.71 - 3.78）。种族/族裔和SES不是钝性和穿透性结肠损伤后造口形成手术决策的可靠预测因素。然而，通过损伤严重度评分计算的损伤严重程度和腹部损伤数量都与结肠造口术和回肠造口术的较高发生率相关。这些数据表明，手术决策取决于围手术期患者的表现，而非种族、族裔或SES。
