Department of Surgery, CHI Health Creighton University Medical Center-Bergan Mercy, Omaha, Nebraska.
Department of Surgery, CHI Health Creighton University Medical Center-Bergan Mercy, Omaha, Nebraska.
J Surg Res. 2020 Jan;245:119-126. doi: 10.1016/j.jss.2019.07.038. Epub 2019 Aug 12.
Data on outcomes after surgery for sigmoid volvulus is limited. The aim of this study was to develop a model to predict need for emergent surgery and mortality after resection for sigmoid volvulus.
The NSQIP database was queried from 2012 to 2016 to identify patients undergoing segmental resection for sigmoid volvulus. Pre-, intra-, and post-operative variables were compared. Primary and secondary outcomes were emergent surgery and risk of mortality, respectively. Chi-square and Fischer's test for categorical variables and the Mann-Whitney test for continuous variables were used. Significant variables for each outcome were entered into a logistic regression model to predict the outcomes.
2086 patients met inclusion criteria. Factors associated with emergency surgery included female gender, relative hematocrit elevation, relative leukocytosis, acute kidney injury, preoperative sepsis, prior functional independence, and bleeding disorders. Laparoscopic resection and mechanical bowel preparation were more commonly used in the nonemergent setting. Patients having emergent resection were more likely to suffer from postoperative superficial surgical site infection, pneumonia, cardiac arrest, septic shock, myocardial infarction, and receive perioperative transfusion. No difference was seen in ileus, readmission or reoperation rates in the emergent and nonemergent groups. Factors predictive of postoperative mortality included increased age, systemic sepsis, and emergent surgery. Independence before illness, higher albumin levels, and lower BMI were shown to be protective.
Emergent resection is independently associated with poor postoperative outcomes and mortality. Predictors of need for emergent resection and mortality identified in this study can be used to aid in shared decision-making for patients with sigmoid volvulus.
关于乙状结肠扭转手术后结果的数据有限。本研究的目的是建立一个预测乙状结肠扭转切除术后急诊手术和死亡率的模型。
从 2012 年至 2016 年，我们对 NSQIP 数据库进行了查询，以确定接受乙状结肠部分切除术治疗的患者。比较了术前、术中、术后的变量。主要和次要结果分别为急诊手术和死亡率。采用卡方和 Fischer 检验进行分类变量，采用 Mann-Whitney 检验进行连续变量。将每个结果的显著变量输入逻辑回归模型，以预测结果。
2086 名患者符合纳入标准。与急诊手术相关的因素包括女性、相对红细胞压积升高、相对白细胞增多、急性肾损伤、术前脓毒症、术前功能独立和出血性疾病。腹腔镜切除和机械肠道准备在非急诊环境中更为常见。接受急诊切除的患者更有可能发生术后浅表手术部位感染、肺炎、心脏骤停、感染性休克、心肌梗死，并接受围手术期输血。在急诊和非急诊组中，肠麻痹、再入院或再次手术的发生率没有差异。术后死亡率的预测因素包括年龄增加、全身脓毒症和急诊手术。术前独立性、较高的白蛋白水平和较低的 BMI 被证明是保护性的。
急诊切除与术后不良结果和死亡率独立相关。本研究确定的急诊手术和死亡率的预测因素可用于帮助乙状结肠扭转患者进行共同决策。
