Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System-Medical Center, Moreno Valley, CA.
Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System-Medical Center, Moreno Valley, CA; Department of Surgery, University of California Riverside, Riverside, CA.
J Am Coll Surg. 2020 Jun;230(6):1045-1053. doi: 10.1016/j.jamcollsurg.2020.03.016. Epub 2020 Mar 27.
The impact of cirrhosis on outcomes of acute colonic diverticulitis (ACD) has been studied infrequently. We investigated the effect of cirrhosis on outcomes of surgical patients with ACD treated by either an open or laparoscopic approach.
A cross-sectional study was performed using the Nationwide Inpatient Sample 2012 to 2014. Patients with ACD were stratified into compensated and decompensated cirrhosis for comparisons of demographic characteristics, hospital length of stay, complications, mortality, and cost. Groups were stratified according to surgical treatment: open colectomy and laparoscopic colectomy. A comparative effectiveness analysis of outcomes was performed between the 2 surgical treatments. Univariate comparisons between groups and multivariate regression analysis were performed to identify risk factors for mortality and specific complications.
Of 1,172,875 patients hospitalized with the diagnosis of ACD during the study period, 1,145 were cirrhotic. The majority were male (59%). There were 660 compensated cirrhotic patients and 485 decompensated cirrhotic patients and all underwent either open (n = 875) or laparoscopic colectomy (n = 270). Consistently, marked increases in mortality, hospital length of stay, and cost were observed in decompensated cirrhotic patients regardless of the type of treatment. Laparoscopic colectomy was accompanied by shorter hospital length of stay, lower costs, and significantly decreased mortality rate compared with open colectomy in compensated and decompensated cirrhotic patients.
The presence of cirrhosis markedly impacts outcomes in patients with ACD, leading to prolonged hospitalization, higher cost, and increased complications and deaths. Laparoscopic colectomy is associated with better outcomes in patients requiring surgical management, including those with decompensated cirrhosis.
肝硬化对急性结肠憩室炎（ACD）结局的影响研究甚少。我们研究了肝硬化对接受开腹或腹腔镜治疗的 ACD 手术患者结局的影响。
使用 2012 年至 2014 年全国住院患者样本进行横断面研究。将 ACD 患者分为代偿性和失代偿性肝硬化，比较其人口统计学特征、住院时间、并发症、死亡率和费用。根据手术治疗将患者分为开腹结肠切除术和腹腔镜结肠切除术。对两种手术治疗的结局进行了比较有效性分析。对组间进行单变量比较，并进行多变量回归分析，以确定死亡率和特定并发症的危险因素。
在研究期间，1172875 例因 ACD 住院的患者中，有 1145 例患有肝硬化。大多数为男性（59%）。有 660 例代偿性肝硬化患者和 485 例失代偿性肝硬化患者，所有患者均接受开腹（n=875）或腹腔镜结肠切除术（n=270）。同样，无论治疗类型如何，失代偿性肝硬化患者的死亡率、住院时间和费用均显著增加。与开腹结肠切除术相比，代偿性和失代偿性肝硬化患者的腹腔镜结肠切除术具有更短的住院时间、更低的成本和显著降低的死亡率。
肝硬化显著影响 ACD 患者的结局，导致住院时间延长、成本增加、并发症和死亡增加。腹腔镜结肠切除术与需要手术治疗的患者（包括失代偿性肝硬化患者）的更好结局相关。
