Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Division of Health Care Policy and Research, The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
J Surg Oncol. 2021 Jan;123(1):261-270. doi: 10.1002/jso.26224. Epub 2020 Oct 1.
Whether bowel preparation utilization rates or effectiveness varies based on tumor location is unknown.
The 2012-2016 American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted participant user file was queried for patients undergoing elective colorectal resection for cancer. Bowel preparation was classified as combined, mechanical bowel preparation alone, oral antibiotic alone, or none. Cochran-Armitage tests were used for trend analysis. Multivariable analyses stratified by tumor location were performed for the outcome of anastomotic leak. An additional multivariable model including all tumor locations assessed for interaction between bowel preparation and tumor location on an anastomotic leak.
A total of 29,739 operations were included and the anastomotic leak rate was 1.9% with combined preparation versus 4.0% without preparation. Combined bowel preparation utilization increased over time as tumor location became more distal (both p < .0001). However, the adjusted effect of combined bowel preparation on anastomotic leak risk reduction did not differ by individual tumor location or across all tumor locations (p = .43 for interaction).
Though the utilization rate of combined bowel preparation increased as tumor location became more distal, its risk-reducing effect remained similar. Quality improvement initiatives should focus on increased utilization of combined bowel preparation with an emphasis on tumors in the ascending colon.
尚不清楚肿瘤位置是否会影响肠道准备的利用率或效果。
检索了 2012-2016 年美国外科医师学会国家外科质量改进计划结肠癌目标参与者用户文件，纳入接受择期结直肠切除术治疗癌症的患者。肠道准备分为联合、单纯机械肠道准备、单纯口服抗生素和无肠道准备。采用 Cochran-Armitage 检验进行趋势分析。对肿瘤位置分层的多变量分析评估了吻合口漏的结果。在包括所有肿瘤位置的另外一个多变量模型中，评估了肠道准备和肿瘤位置之间是否存在吻合口漏的交互作用。
共纳入 29739 例手术，联合准备组吻合口漏发生率为 1.9%，无准备组为 4.0%。随着肿瘤位置变得更远端，联合肠道准备的使用率逐渐增加（两者均 p<0.0001）。然而，联合肠道准备对吻合口漏风险降低的影响在不同肿瘤位置或所有肿瘤位置上并无差异（交互作用 p=0.43）。
尽管随着肿瘤位置变得更远端，联合肠道准备的使用率有所增加，但它的风险降低效果仍然相似。质量改进计划应重点提高联合肠道准备的使用率，并特别关注升结肠的肿瘤。
