Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: https://twitter.com/Brian_D_Lo.
Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Surgery. 2021 Oct;170(4):1047-1053. doi: 10.1016/j.surg.2021.03.058. Epub 2021 Apr 28.
Preoperative steroid use has been associated with worse surgical outcomes. The purpose of this study was to determine whether laparoscopic surgery reduces the risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use.
Patients with ulcerative colitis undergoing a total abdominal colectomy were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2005-2019). Patients were stratified based on preoperative chronic steroid use and operative approach (open versus laparoscopic). The primary outcome was septic shock/sepsis. Multivariable regression models were used to assess the association between laparoscopic surgery and rates of septic shock/sepsis among steroid users and non-steroid users in both the elective and emergent settings.
Among 8,644 patients undergoing a total abdominal colectomy, 67.1% were steroid users and 32.9% were non-steroid users. Compared with an open approach, elective laparoscopic surgery was associated with lower rates of septic shock/sepsis, albeit with higher readmission rates for both steroid users (15.1% [laparoscopic] vs 12.0% [open], P = .005) and non-steroid users (12.6% [laparoscopic] vs 9.4% [open], P = .019). On adjusted analysis, ulcerative colitis patients with chronic steroid use undergoing an elective laparoscopic total abdominal colectomy demonstrated a reduced risk of septic shock/sepsis compared to open surgery (odds ratio 0.61, 95% confidence interval 0.49-0.76, P < .001). Similar findings were seen among chronic steroid users undergoing emergent laparoscopic procedures (odds ratio 0.54, 95% confidence interval 0.31-0.95, P = .031).
Laparoscopic surgery was associated with a reduced risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use, suggesting that minimally invasive surgery may be a promising option among this unique patient population.
术前使用类固醇与手术结果恶化有关。本研究旨在确定腹腔镜手术是否降低了术前长期使用类固醇的溃疡性结肠炎患者发生脓毒症性休克/败血症的风险。
从美国外科医师学会国家外科质量改进计划（NSQIP）数据库（2005-2019 年）中确定接受全腹部结肠切除术的溃疡性结肠炎患者。根据术前慢性类固醇使用情况和手术方式（开放与腹腔镜）对患者进行分层。主要结局是脓毒症性休克/败血症。多变量回归模型用于评估在选择性和紧急情况下，类固醇使用者和非类固醇使用者中，腹腔镜手术与脓毒症性休克/败血症发生率之间的关联。
在 8644 例接受全腹部结肠切除术的患者中，67.1%为类固醇使用者，32.9%为非类固醇使用者。与开放手术相比，选择性腹腔镜手术的脓毒症性休克/败血症发生率较低，但类固醇使用者（15.1%[腹腔镜]与 12.0%[开放]，P=0.005）和非类固醇使用者（12.6%[腹腔镜]与 9.4%[开放]，P=0.019）的再入院率更高。在调整分析中，与开放性手术相比，接受选择性腹腔镜全腹部结肠切除术的慢性类固醇使用者溃疡性结肠炎患者发生脓毒症性休克/败血症的风险降低（优势比 0.61，95%置信区间 0.49-0.76，P<0.001）。在接受紧急腹腔镜手术的慢性类固醇使用者中也观察到类似的结果（优势比 0.54，95%置信区间 0.31-0.95，P=0.031）。
腹腔镜手术与术前长期使用类固醇的溃疡性结肠炎患者发生脓毒症性休克/败血症的风险降低相关，这表明微创外科手术可能是这一独特患者群体的一种有前途的选择。
