微创 Ivor Lewis 食管切除术的再次手术。
Reoperative Surgery After Minimally Invasive Ivor Lewis Esophagectomy.
机构信息
Department of Surgery.
Center for Data Solutions, University of Florida College of Medicine.
出版信息
Surg Laparosc Endosc Percutan Tech. 2021 Sep 9;32(1):60-65. doi: 10.1097/SLE.0000000000000996.
OBJECTIVE
The aim of this study is to identify factors influencing reoperations following minimally invasive Ivor Lewis esophagectomy and associated mortality and hospital costs.
MATERIALS AND METHODS
Between 2013 and 2018, 125 patients were retrospectively analyzed. Outcomes included reoperations, mortality, and hospital costs. Multivariable logistic regression analyses determined factors associated with reoperations.
RESULTS
In-hospital reoperations (n=10) were associated with in-hospital mortality (n=3, P<0.01), higher hospital costs (P<0.01), and longer hospital stay (P<0.01). Conversely, reoperations after discharge were not associated with mortality. By multivariable analysis, baseline cardiovascular (P=0.02) and chronic kidney disease (P=0.01) were associated with reoperations. However, anastomotic leaks were not associated with reoperations nor mortality.
CONCLUSION
The majority of reoperations occur within 30 days often during index hospitalization. Reoperations were associated with increased in-hospital mortality and hospital costs. Notably, anastomotic leaks did not influence reoperations nor mortality. Efforts to optimize patient baseline comorbidities should be emphasized to minimize reoperations following minimally invasive Ivor Lewis esophagectomy.
目的
本研究旨在确定影响微创 Ivor Lewis 食管切除术术后再次手术的因素，以及与死亡率和住院费用相关的因素。
材料和方法
对 2013 年至 2018 年间的 125 例患者进行回顾性分析。结果包括再次手术、死亡率和住院费用。多变量逻辑回归分析确定了与再次手术相关的因素。
结果
院内再次手术（n=10）与院内死亡率（n=3，P<0.01）、更高的住院费用（P<0.01）和更长的住院时间（P<0.01）相关。相反，出院后的再次手术与死亡率无关。通过多变量分析，基线心血管疾病（P=0.02）和慢性肾脏病（P=0.01）与再次手术相关。然而，吻合口漏与再次手术或死亡率无关。
结论
大多数再次手术发生在 30 天内，通常在住院期间。再次手术与住院期间死亡率和住院费用增加相关。值得注意的是，吻合口漏并不影响再次手术或死亡率。应强调优化患者基线合并症的措施，以尽量减少微创 Ivor Lewis 食管切除术后的再次手术。
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