Jiang Zhizhao, Ren Jianan, Ren Huajian, Hong Zhiwu, Wang Gefei, Gu Guosheng, Wu Xiuwen
From the *Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, P R China and.
Am Surg. 2020 Apr 1;86(4):346-353.
Enterocutaneous fistulas (ECFs) requiring admission to ICU is a serious surgical complication. A growing number of patients survive ECFs but remain chronically critically ill. The aim of our study was to investigate the risk factors of hospital death in patients with chronic critical illness attributed to ECFs. A retrospective single-center study was conducted in 163 ECF patients between 2013 and 2017. Patient-specific baseline characteristics, outcomes, and process of care variables were collected. Risk factors for hospital mortality were determined using univariate and multivariate analyses. Patients were divided into the following two groups according to the hospital discharge outcome: group survivors (n = 106) and group nonsurvivors (n = 57). Patients who received active irrigation-suction drainage (AISD) within 24 hours after the diagnosis of ECFs had a significantly lower hospital mortality rate than those who received AISD after more than 24 hours (17.9% 46.9%, < 0.001). Multivariate logistic regression analysis demonstrated that delayed AISD (adjusted odds ratio [AOR], 10.24; 95% confidence interval [CI], 3.03-34.59; < 0.001) and no rehabilitation therapy (AOR, 4.77; 95% CI, 1.43-15.98; = 0.011) were independently associated with a greater risk of hospital mortality. The hospital mortality rate in patients with more than or equal to four risk factors was 92.6 per cent (n = 57), compared with a mortality rate of 9.4 per cent (n = 106) in patients who did not have these risk factors ( < 0.001). The risk of hospital death is exceptionally high among patients with chronic critical illness attributed to ECFs. Efforts aimed at early AISD and rehabilitation therapy are likely to be associated with improved clinical outcomes.
需要入住重症监护病房（ICU）的肠皮肤瘘（ECF）是一种严重的手术并发症。越来越多的患者在ECF后存活下来，但仍长期处于危重症状态。我们研究的目的是调查因ECF导致的慢性危重症患者的医院死亡风险因素。2013年至2017年间，对163例ECF患者进行了一项回顾性单中心研究。收集了患者的特定基线特征、结局和护理过程变量。使用单因素和多因素分析确定医院死亡率的风险因素。根据出院结局将患者分为以下两组：存活组（n = 106）和非存活组（n = 57）。在诊断ECF后24小时内接受积极冲洗吸引引流（AISD）的患者的医院死亡率显著低于在24小时后接受AISD的患者（17.9%对46.9%，P<0.001）。多因素逻辑回归分析表明，延迟AISD（调整后的优势比[AOR]，10.24；95%置信区间[CI]，3.03 - 34.59；P<0.001）和未接受康复治疗（AOR，4.77；95%CI，1.43 - 15.98；P = 0.011）与更高的医院死亡风险独立相关。有四个及以上风险因素的患者的医院死亡率为92.6%（n = 57），而没有这些风险因素的患者的死亡率为9.4%（n = 106）（P<0.001）。在因ECF导致的慢性危重症患者中，医院死亡风险极高。旨在早期进行AISD和康复治疗的努力可能会改善临床结局。
