Brungardt Joseph G, Miller Caleb S, Schropp Kurt P
The University of Kansas, Department of Surgery 4000 Cambridge, M/S 2005, Kansas, KS 66160, USA.
The University of Kansas, Department of Urology 3901 Rainbow Blvd, M/S 3016, Kansas, KS 66160, USA.
Am J Clin Exp Urol. 2020 Aug 15;8(4):133-139. eCollection 2020.
Within the adult population, studies of the granular clinical outcomes of appendicovesicostomy (AV) and augmentation enterocystoplasty (AE) have been limited to case series. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data, this study sought to describe the population undergoing these procedures. An analysis of the ACS NSQIP database (2015 to 2018) was performed, capturing patients with procedure codes of enterocystoplasty with intestinal anastomosis or cutaneous appendicovesicostomy. Patients were stratified into three groups, if they underwent either procedure, or both procedures. Demographics, comorbidities, perioperative variables, surgeon specialty, and outcomes were described. 130 patients undergoing AV or AE were captured. Most of these patients were white (70.77%) and middle aged (46.78±17.33 years). Most patients were an American Society of Anesthesiologists class 3 or greater risk (71.54%). A higher percentage of AE patients were readmitted, returned to the operating room, and had postoperative UTI or sepsis compared to those undergoing AV or AV+AE. The most common complication overall was readmission related to the operation (14.62%). The most common postoperative diagnosis was neurogenic related in over half of cases. The study shows patients undergoing bladder augmentation and appendicovesicostomy are readmitted not infrequently. Risk of infection, sepsis, bleeding, and reoperation are also not insignificant. Further studies should be carried out to aid in decreasing complication rate and readmissions after these procedures.
在成年人群中,关于阑尾膀胱造口术(AV)和扩大肠膀胱成形术(AE)具体临床结局的研究仅限于病例系列。本研究利用美国外科医师学会国家外科质量改进计划(ACS NSQIP)的数据,试图描述接受这些手术的人群。对ACS NSQIP数据库(2015年至2018年)进行了分析,纳入了具有肠吻合术或皮肤阑尾膀胱造口术手术编码的患者。如果患者接受了其中一种手术或两种手术,则将其分为三组。描述了人口统计学、合并症、围手术期变量、外科医生专业和结局。共纳入130例接受AV或AE手术的患者。这些患者大多为白人(70.77%),且为中年(46.78±17.33岁)。大多数患者属于美国麻醉医师协会3级或更高风险类别(71.54%)。与接受AV或AV+AE手术的患者相比,接受AE手术的患者再次入院、返回手术室以及术后发生尿路感染或脓毒症的比例更高。总体上最常见的并发症是与手术相关的再次入院(14.62%)。超过半数病例中最常见的术后诊断与神经源性相关。该研究表明,接受膀胱扩大术和阑尾膀胱造口术的患者经常再次入院。感染、脓毒症、出血和再次手术的风险也不容小觑。应开展进一步研究以帮助降低这些手术后的并发症发生率和再次入院率。