Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
University of South Carolina, Department of Computer Science and Engineering, Columbia, SC.
J Surg Res. 2021 Sep;265:168-179. doi: 10.1016/j.jss.2021.03.048. Epub 2021 Apr 30.
Colonic stent placement can avoid urgent surgery for large bowel obstruction in selected patients. Population-wide stent utilization patterns and outcomes are unknown.
Using retrospective, population-based, Nationwide Inpatient Sample data, we studied patients with colonic stents discharged during 2010-2015. The primary outcome was ostomy creation during the same hospitalization. Other outcomes were perforation or peritonitis, and in-hospital death. Associations of outcomes with stent indication were investigated, adjusting for patient-, admission-, and hospital characteristics. We estimated annual population-wide stent use volumes.
Of 4257 patients with stent placement (52% male, mean age 64.6 years), 9.9% had non-metastatic colon cancer, 12.9% metastatic colon cancer, 37.8% extracolonic malignancy (ECM), and 39.3% had benign obstruction. In 8.1% of patients, ostomy creation surgery was performed. Perforation or peritonitis occurred in 16.7%, and in-hospital death in 4.5%. Relative to ECM, ostomy creation was several-fold more likely among nonmetastatic colon cancer (adjusted odds ratio (OR) 3.4; 95%CI, 2.1-5.5), metastatic colon cancer (adjusted OR 2.5; 95%CI, 1.7-3.7), and benign obstruction patients (adjusted OR 3.1; 95%CI, 2.1-4.7). Benign obstruction was associated with high risk of perforation/peritonitis (adjusted OR 3.1 relative to non-metastatic CC (95%CI, 2.1-4.5)). Perforation/peritonitis was highly associated with inpatient death (adjusted OR 6.8 (95%CI, 4.9-9.5)). Annually, about 3,580 patients underwent stent placement, with benign obstruction showing an increasing trend (P=0.0002).
Over 75% of stent placements were done for patients with benign disease and ECM obstruction. Subsequent ostomy creation during the hospitalization was least likely among ECM patients. Rates of perforation/peritonitis in benign obstructions were concerningly high. (22.2%).
在选定的患者中，结肠支架置入术可避免大肠梗阻的紧急手术。目前尚不清楚在人群中支架使用的模式和结果。
我们使用回顾性、基于人群的全国住院患者样本数据，研究了 2010 年至 2015 年期间出院的带结肠支架的患者。主要结局是同一住院期间行造口术。其他结局包括穿孔或腹膜炎以及院内死亡。通过调整患者、入院和医院特征，研究了与支架适应证相关的结果。我们估计了每年人群中支架使用量。
在 4257 例带支架置入的患者中（52%为男性，平均年龄 64.6 岁），9.9%为非转移性结肠癌，12.9%为转移性结肠癌，37.8%为结外恶性肿瘤（ECM），39.3%为良性梗阻。在 8.1%的患者中进行了造口术。穿孔或腹膜炎的发生率为 16.7%，院内死亡率为 4.5%。与 ECM 相比，非转移性结肠癌（调整后的优势比[OR]3.4；95%CI，2.1-5.5）、转移性结肠癌（调整后的 OR 2.5；95%CI，1.7-3.7）和良性梗阻患者（调整后的 OR 3.1；95%CI，2.1-4.7）发生造口术的可能性大得多。良性梗阻与穿孔/腹膜炎风险增加相关（相对于非转移性 CC，调整后的 OR 3.1（95%CI，2.1-4.5））。穿孔/腹膜炎与住院死亡高度相关（调整后的 OR 6.8（95%CI，4.9-9.5））。每年约有 3580 例患者接受支架置入，其中良性梗阻呈上升趋势（P=0.0002）。
超过 75%的支架置入是为良性疾病和 ECM 梗阻患者进行的。在 ECM 患者中，随后在住院期间行造口术的可能性最小。良性梗阻患者中穿孔/腹膜炎的发生率高得令人担忧（22.2%）。
