一项关于成人小肠梗阻急诊或紧急手术的丹麦研究：发病率、病因、抗生素使用及感染性并发症

A Danish study on emergency or urgent surgery for small bowel obstruction in adults: Incidence, causes, administration of antibiotics, and infectious complications.

作者信息

Boolsen Anders Watt, Brandstrup Birgitte

机构信息

Department of Surgery, Holbæk Hospital, Part of Copenhagen University Hospitals, Smedelundsgade 60, DK-4300 Holbæk, Denmark.

Institute for Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 København N, Denmark.

出版信息

Surg Open Sci. 2021 Dec 1;7:30-35. doi: 10.1016/j.sopen.2021.11.004. eCollection 2022 Jan.

DOI:10.1016/j.sopen.2021.11.004

PMID:35005586

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8719015/

Abstract

BACKGROUND

Small bowel obstruction is potentially life-threatening; however, the incidence of surgery for small bowel obstruction is unknown, the patient characteristics are poorly described, and the triggers for giving antibiotics with possible influence on complications are unclear. The aims of this study were to fill these gaps to describe the incidence and the characteristics of patients undergoing surgery for small bowel obstruction and to identify triggers for giving antibiotics and the association with postoperative infections.

METHODS

From July 1, 2014, to July 31, 2015, we included adult patients undergoing surgery for small bowel obstruction at 3 hospitals representing one Danish region. We collected information on patient characteristics, diagnosis, antibiotics, and infectious complications until postoperative day 90 and survival until 1 year.

RESULTS

The 3 hospitals serve a population of 656,353 adults, and treatment is free of charge. A total of 192 patients underwent emergency surgery for small bowel obstruction in the period (incidence: 27/100,000 citizens or 1,200 operations in Denmark annually). The patients with small bowel obstruction had adhesive obstruction (62%), neoplasms (11%), or hernias (7%). A total of 83% received antibiotic prophylaxis, and triggers were preoperative elevated C-reactive protein [odds ratio (95% confidence intervals): 2.49 (1.04-5.98),  = .041] or resection of the bowel [3.10 (1.22-7.89),  = .017]. The incidence of postoperative infections was not reduced among patients receiving antibiotics.

CONCLUSION

We found that 27/100,000 patients undergo surgery for small bowel obstruction in Denmark each year. Adhesive obstruction was the primary reason (62%). A total of 83% received prophylactic antibiotics triggered by elevated C-reactive protein or bowel resection. We found no association between antibiotic use and infectious complications.

摘要

背景

小肠梗阻有潜在生命危险；然而，小肠梗阻手术的发生率尚不清楚，患者特征描述欠佳，且使用抗生素对并发症可能产生影响的触发因素尚不明确。本研究的目的是填补这些空白，描述接受小肠梗阻手术患者的发生率和特征，并确定使用抗生素的触发因素及其与术后感染的关联。

方法

从2014年7月1日至2015年7月31日，我们纳入了丹麦一个地区3家医院接受小肠梗阻手术的成年患者。我们收集了患者特征、诊断、抗生素使用及感染并发症相关信息，直至术后第90天，并收集了1年生存率信息。

结果

这3家医院服务于656,353名成年人口，且治疗免费。在此期间共有192例患者接受了小肠梗阻急诊手术（发生率：27/100,000居民，或丹麦每年1200例手术）。小肠梗阻患者中粘连性梗阻占62%，肿瘤占11%，疝占7%。共有83%的患者接受了抗生素预防，触发因素为术前C反应蛋白升高[比值比（95%置信区间）：2.49（1.04 - 5.98），P = 0.041]或肠切除术[3.10（1.22 - 7.89），P = 0.017]。接受抗生素治疗的患者术后感染发生率并未降低。