Updates Surg. 2020 Sep;72(3):811-819. doi: 10.1007/s13304-020-00753-2. Epub 2020 May 12.
Purpose of the present study is to analyze risk factors for adverse events after elective colorectal resection. A wide range of adverse events after elective colorectal surgery was reported, anastomotic leakage (AL) and related morbidity and mortality being the most feared ones. Clear definition of risk factors is crucial to limit the related mortality. Prospective, 1-year multicenter enrollment of 1546 elective colorectal resections with anastomosis. Endpoints were anastomotic leakage (AL), overall morbidity, major morbidity and mortality rates (ClinicalTrials.gov; Identifier: NCT03560180). AL rate was 4.92%. Overall morbidity, major morbidity and mortality rates were 30.20%, 9.76% and 1.29%, respectively. Intra- and/or postoperative blood transfusion(s) was the only variable independently influencing all the endpoints: Odds ratios (OR) were 8.15 for AL, 19.33 for overall morbidity, 10.17 for major morbidity and 3.70 for mortality); overall morbidity rates were also independently influenced by American Society of Anesthesiologists class III vs I-II and extra- vs intra-corporeal anastomosis (OR 1.57 and 1.49, respectively); major morbidity rates were also independently influenced by female vs male gender and by the length of the procedure (OR 0.60 and 1.004, respectively); mortality rates were also independently influenced by increasing age (OR 1.16). This study clearly identifies intra- and/or postoperative blood transfusion(s) as an independent risk factor for all adverse events after elective colorectal surgery.
本研究旨在分析择期结直肠切除术后不良事件的危险因素。择期结直肠手术后会出现多种不良事件，吻合口漏（AL）及其相关发病率和死亡率是最令人担忧的。明确危险因素的定义对于限制相关死亡率至关重要。前瞻性、为期 1 年、在 1546 例择期结直肠吻合术患者中进行的多中心研究。研究终点为吻合口漏（AL）、总发病率、主要发病率和死亡率（ClinicalTrials.gov；标识符：NCT03560180）。AL 发生率为 4.92%。总发病率、主要发病率和死亡率分别为 30.20%、9.76%和 1.29%。术中及/或术后输血是唯一独立影响所有研究终点的变量：比值比（OR）分别为 AL 8.15、总发病率 19.33、主要发病率 10.17 和死亡率 3.70；总发病率还独立受美国麻醉医师协会（ASA）分级 III 与 I-II 和体外与体内吻合的影响（OR 分别为 1.57 和 1.49）；主要发病率还独立受女性与男性及手术时间的影响（OR 分别为 0.60 和 1.004）；死亡率还独立受年龄增加的影响（OR 1.16）。本研究明确将术中及/或术后输血确定为择期结直肠手术后所有不良事件的独立危险因素。
