Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, OH.
Surgery. 2022 Mar;171(3):799-805. doi: 10.1016/j.surg.2021.09.012. Epub 2021 Oct 29.
The use of component separation technique (CST) in complex abdominal wall reconstruction (AWR) increases the rate of primary musculofascial closure but can be associated with increased wound complications, which may require readmission. This study examines 3-year trends in readmissions for patients undergoing AWR with or without CST.
The Nationwide Readmissions Database was queried for patients undergoing elective AWR from 2016-2018. CST, demographic characteristics, and 90-day complications and readmissions were determined. CST versus non-CST readmissions were compared, including matched subgroups. Standard statistics and logistic regression were used.
Over the 3-year period, 94,784 patients underwent AWR. There was an annual increase in the prevalence of CST: 4.0% in 2016; 6.1% in 2017; 6.7% in 2018 (P < .01), which is a 67.5% upsurge during that time. Most cases (82.3%) occurred at urban teaching hospitals, which had more comorbid patients (P < .01). The yearly 90-day readmission rate did not change: 16.0%, 18.2%, and 16.9% (P = .26). Readmissions were higher for CST patients than non-CST patients (17.1% vs 15.7%), but not in the matched subgroup (17.0% vs 16.4%; P = .41). Most commonly, readmissions were for infection (28.3%); 14.3% of readmitted patients underwent reoperation. Smoking, morbid obesity, diabetes, chronic lung disease, urban-teaching hospital status, and increased length of stay increased the chance of readmission (all P < .05).
From 2016 to 2018, the use of CST increased 67.5% nationwide without an increase in readmissions. As we look toward clinical targets to reduce risk of readmission, modifiable health conditions, such as smoking, morbid obesity, and diabetes should be targeted during the prehabilitation process.
在复杂腹壁重建（AWR）中使用组件分离技术（CST）会增加初次肌肉筋膜闭合的比率，但可能会增加伤口并发症，这可能需要再次入院。本研究检查了 2016 年至 2018 年期间接受 AWR 手术且使用或不使用 CST 的患者 3 年的再入院趋势。
从 2016 年至 2018 年，全国再入院数据库中查询接受择期 AWR 的患者。确定 CST、人口统计学特征以及 90 天并发症和再入院情况。比较 CST 与非 CST 的再入院情况，包括匹配亚组。采用标准统计学和逻辑回归。
在 3 年期间，94784 例患者接受了 AWR。CST 的流行率呈逐年上升趋势：2016 年为 4.0%；2017 年为 6.1%；2018 年为 6.7%（P<0.01），在此期间增加了 67.5%。大多数病例（82.3%）发生在城市教学医院，这些医院的合并症患者更多（P<0.01）。90 天的年再入院率没有变化：16.0%、18.2%和 16.9%（P=0.26）。CST 患者的再入院率高于非 CST 患者（17.1%比 15.7%），但在匹配亚组中无差异（17.0%比 16.4%；P=0.41）。最常见的再入院原因是感染（28.3%）；14.3%的再入院患者接受了再次手术。吸烟、病态肥胖、糖尿病、慢性肺部疾病、城市教学医院状态和住院时间延长增加了再入院的机会（所有 P<0.05）。
2016 年至 2018 年，全国范围内 CST 的使用增加了 67.5%，而再入院率没有增加。当我们着眼于降低再入院风险的临床目标时，应该在康复前阶段针对吸烟、病态肥胖和糖尿病等可改变的健康状况进行目标治疗。
