232890Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Division of General Surgery, Long Island Jewish Medical Center, 5799Northwell Health, Queens, NY, USA.
Am Surg. 2021 Aug;87(8):1327-1333. doi: 10.1177/0003134820971623. Epub 2020 Dec 19.
Colonic perforation often requires emergent intervention and carries high morbidity and mortality. The objective of this study was to determine whether nonclinical factors, such as transition of care from outpatient facilities to inpatient settings, are associated with increased risk of mortality in patients who underwent emergent surgical intervention for colonic perforation.
Using the 2006-2015 ACS National Surgical Quality Improvement Program database, we identified adult patients who underwent emergent partial colectomy with primary anastomosis ± protecting ostomy or partial colectomy with ostomy with intraoperative finding of wound class III or IV for a diagnosis of perforated viscus. The outcome of interest was 30-day postoperative mortality. Univariate and multivariate analyses using logistic regression were performed.
4705 patients met criteria, of which 841 (17.9%) died. Univariate analysis showed that patients who died after emergent surgery for perforated viscus were more likely to present from a chronic care facility (13.4% vs. 4.4%, < .0001) and had longer time from admission to undergoing surgery (mean 4.1 vs. 2.0 days, < .0001. Logistic regression demonstrated that septic shock vs. none (OR 3.60, < .0001), sepsis vs. none (OR 1.57, = .00045), transfer from chronic care facility vs. home (OR 1.87, < .0001), and increased time from admission vs. operation (OR 1.01, = .0055) were independently associated with increased risk of death.
Transfer from a chronic care facility was independently associated with increased mortality in patients undergoing emergent surgery for perforated viscus.
结肠穿孔常需要紧急干预，且具有较高的发病率和死亡率。本研究的目的是确定非临床因素（例如从门诊设施向住院设施的医疗过渡）是否与接受紧急手术治疗结肠穿孔的患者的死亡率增加相关。
我们使用 2006-2015 年 ACS 国家手术质量改进计划数据库，确定了接受急诊部分结肠切除术伴一期吻合术±保护性造口术或部分结肠切除术伴造口术且术中发现伤口 III 或 IV 级的成年患者，诊断为穿孔性内脏。感兴趣的结果是 30 天术后死亡率。使用逻辑回归进行单变量和多变量分析。
4705 名患者符合标准，其中 841 名（17.9%）死亡。单变量分析显示，接受急诊手术治疗穿孔性内脏的患者更有可能从慢性病护理机构就诊（13.4%比 4.4%，<.0001），并且从入院到接受手术的时间更长（平均 4.1 天比 2.0 天，<.0001）。逻辑回归表明，感染性休克比无感染性休克（OR 3.60，<.0001），败血症比无败血症（OR 1.57，=.00045），从慢性病护理机构转移比家庭（OR 1.87，<.0001），以及从入院到手术的时间增加（OR 1.01，=.0055）与死亡风险增加独立相关。
从慢性病护理机构转移与接受紧急手术治疗穿孔性内脏的患者死亡率增加独立相关。
