艰难梭菌相关性结肠炎的非手术治疗时间延长与死亡率、并发症和费用增加有关。

Prolonged non-operative management of clostridium difficile colitis is associated with increased mortality, complications, and cost.

机构信息

Department of Surgery, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.

Center for Advanced Surgical Technology, Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6245, USA.

出版信息

Am J Surg. 2019 Jun;217(6):1042-1046. doi: 10.1016/j.amjsurg.2019.01.017. Epub 2019 Jan 24.

DOI:10.1016/j.amjsurg.2019.01.017

PMID:30709552

Abstract

BACKGROUND

We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI).

METHODS

The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded. Chi-square, Fisher's exact, student T-test, and logistic regression were performed with α = 0.05.

RESULTS

Logistic regression analyses using days from admission to surgery (DATO), age, race, and gender demonstrated that increased DATO was associated with higher 30-day mortality (OR 1.022, 95% CI 1.001-1.044, p = 0.040), overall complications (OR 1.034, 95% CI 1.014-1.054, p = 0.001), and infectious complications (OR 1.040, 95% CI 1.018-1.062, p < 0.001) compared to age for all three outcomes. Total length of stay (LOS), intensive care unit LOS, and direct cost increased in conjunction with DATO (p < 0.001).

CONCLUSIONS

Early surgical intervention in appropriately selected patients should be considered when there is a high suspicion for prolonged non-operative treatment.

摘要

背景

我们旨在研究对患有严重艰难梭菌感染（CDI）的患者延迟手术对结局和成本的影响。

方法

在 Vizient 数据库中查询接受开放性全腹部结肠切除术（TAC）的 CDI 患者。排除入院当天接受手术的患者。采用卡方检验、Fisher 确切检验、学生 T 检验和逻辑回归分析，α 值为 0.05。

结果

使用入院至手术的天数（DATO）、年龄、种族和性别进行的逻辑回归分析表明，DATO 增加与 30 天死亡率（OR 1.022，95%CI 1.001-1.044，p=0.040）、总并发症（OR 1.034，95%CI 1.014-1.054，p=0.001）和感染性并发症（OR 1.040，95%CI 1.018-1.062，p<0.001）相关，而年龄对所有三个结局的影响均小于 DATO。总住院时间（LOS）、重症监护病房 LOS 和直接费用随 DATO 增加而增加（p<0.001）。