Nazzani Sebastiano, Bandini Marco, Preisser Felix, Mazzone Elio, Marchioni Michele, Tian Zhe, Stubinski Robert, Clementi Maria Chiara, Saad Fred, Shariat Shahrokh F, Montanari Emanuele, Briganti Alberto, Carmignani Luca, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy.
Surg Oncol. 2019 Mar;28:201-207. doi: 10.1016/j.suronc.2019.01.011. Epub 2019 Jan 29.
Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used.
Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges.
Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively.
Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.
自2001年起已制定并实施了术后加速康复（ERAS）方案，该方案可能已显著降低了包括麻痹性肠梗阻在内的几种并发症类型的发生率。然而，目前尚无针对当代大型外科肿瘤手术术后麻痹性肠梗阻发生率的正式分析。我们研究了十种主要肿瘤外科手术术后麻痹性肠梗阻的时间趋势。同时还研究了麻痹性肠梗阻对住院时间（LOS）和医院总费用的影响。采用了单变量和多变量线性及逻辑回归分析。
2003年至2013年期间，我们在全国住院患者样本中回顾性识别了接受前列腺切除术、结肠切除术、膀胱切除术、乳房切除术、胃切除术、子宫切除术、肾切除术、卵巢切除术、肺切除术或胰腺切除术的患者。我们的分析共纳入了3431602例患者。使用线性回归评估主要肿瘤外科手术后年度麻痹性肠梗阻发生率的差异。采用多变量逻辑回归分析来检验麻痹性肠梗阻发生率的决定因素，以及麻痹性肠梗阻发生率对住院时间和医院费用的影响。
在十种接受检查的主要肿瘤外科手术后，麻痹性肠梗阻发生率从0.1%（乳房切除术）至23.2%（膀胱切除术）不等。总体年度麻痹性肠梗阻发生率未发生变化[估计年度百分比变化（EAPC）为+0.1%，p = 0.7]。多变量逻辑回归得出的麻痹性肠梗阻预测概率（PP）在膀胱切除术（PP：26.1%）和结肠切除术（PP：17.15%）中最高，而在肺切除术（PP：2.22%）和乳房切除术（PP：0.16%）中最低。在预测住院时间高于第75百分位数的分析中，乳房切除术（OR：14.66）和前列腺切除术（OR：13.21）后的麻痹性肠梗阻影响分别位列最高和第二高。在预测医院费用高于第75百分位数的分析中，乳房切除术（OR：2.21）和卵巢切除术（OR：1.99）后的麻痹性肠梗阻影响分别位列最高和第二高。
尽管实施了ERAS方案，但麻痹性肠梗阻发生率并未随时间下降。胃肠道手术是麻痹性肠梗阻的主要促成因素之一。此外，住院时间短的手术是住院时间增加和住院费用增加的最强相对促成因素。
