急危重症普通外科术后肠外瘘：死亡率、再入院率和经济负担。
Enterocutaneous fistula after emergency general surgery: Mortality, readmission, and financial burden.
机构信息
From the Department of Surgery (J.S.H., J.P., C.E.S.), Division of Traumatology, Surgical Critical Care and Emergency Surgery (E.J.K., D.S., D.N.H.), College of Arts and Sciences (L.W.M.), Department of General Internal Medicine (R.X.), and Center for Clinical Epidemiology and Biostatistics (D.N.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2020 Jul;89(1):167-172. doi: 10.1097/TA.0000000000002673.
BACKGROUND
The burden of enterocutaneous fistula (ECF) after emergency general surgery (EGS) has not been rigorously characterized. We hypothesized that ECF would be associated with higher rates of postdischarge mortality and readmissions.
METHODS
Using the 2016 National Readmission Database, we conducted a retrospective study of adults presenting for gastrointestinal (GI) surgery. Cases were defined as emergent if they were nonelective admissions with an operation occurring on hospital day 0 or 1. We used International Classification of Diseases, 10th Revision, code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90-day readmission rates censuring discharges occurring in December or from October to December, respectively.
RESULTS
A total of 135,595 patients underwent emergency surgery; 1,470 (1.1%) developed ECF. Mortality was higher in EGS patients with ECF than in those without (10.1% vs. 5.4%; odds ratio [OR], 1.99; 95% confidence interval [CI], 1.67-2.36) among patients who survived the index admission. Readmission rates were higher for EGS patients with ECF than without at 30 days (31.0% vs. 12.6%; OR, 3.12; 95% CI, 2.76-3.54) and at 90 days (51.1% vs. 20.1%; OR, 4.15; 95% CI, 3.67-4.70). Similar increases were shown in elective GI surgery.
CONCLUSIONS
Enterocutaneous fistula after GI EGS is associated with significantly increased odds of mortality and readmission, with rates continuing to climb out to at least 90 days. Processes of care designed to mitigate risk in this high-risk cohort should be developed.
LEVEL OF EVIDENCE
Prognostic and Epidemiological Study, Level III.
背景
急诊普通外科（EGS）后肠外瘘（ECF）的负担尚未得到严格描述。我们假设 ECF 与更高的出院后死亡率和再入院率相关。
方法
使用 2016 年国家再入院数据库，我们对接受胃肠（GI）手术的成年人进行了回顾性研究。如果患者是无选择性入院，并且在入院第 0 天或第 1 天进行手术，则将其定义为紧急情况。我们使用国际疾病分类，第 10 版，代码 K63.2（肠瘘）来识别术后瘘。我们测量死亡率和 30 天和 90 天的再入院率，分别为 12 月或 10 月至 12 月出院的患者。
结果
共有 135595 例患者接受了急诊手术；1470 例（1.1%）发生 ECF。与在索引入院期间存活的患者相比，EGS 患者发生 ECF 后死亡率更高（10.1% vs. 5.4%；优势比[OR]，1.99；95%置信区间[CI]，1.67-2.36）。在 30 天（31.0% vs. 12.6%；OR，3.12；95% CI，2.76-3.54）和 90 天（51.1% vs. 20.1%；OR，4.15；95% CI，3.67-4.70）时，ECF 患者的再入院率更高。在选择性 GI 手术中也显示出类似的增加。
结论
GI EGS 后肠外瘘与死亡率和再入院率显著增加相关，至少在 90 天内仍在持续攀升。应制定旨在降低这一高危人群风险的护理流程。
证据水平
预后和流行病学研究，III 级。
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