Quinn Seth, Akram Warqaa, Hao Scarlett, Honaker Michael D
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
J Am Med Dir Assoc. 2022 Apr;23(4):616-622.e1. doi: 10.1016/j.jamda.2022.02.001. Epub 2022 Mar 1.
To compare outcomes in emergent surgical treatment of acute diverticulitis in the older population.
Retrospective multi-institute database cohort analysis.
American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) and NSQIP Colectomy Targeted Database.
The American College of Surgeons National Surgical Quality Improvement Project Colectomy Targeted Database was merged with the main participate use file to identify adult patients undergoing emergent Hartmann procedure or primary anastomosis with diverting loop ileostomy for acute diverticulitis. Patients were subdivided into age cohorts (<65 years, 65-79 years, ≥80 years) and primary postoperative outcomes including mortality, morbidity, and readmission were compared using multivariate regression.
A total of 6091 patients were identified. On multivariate analysis, 30-day mortality was higher in patients undergoing a Hartmann procedure aged 65-79 years [odds ratio (OR) 2.39, P < .001] and ≥80 years (OR 6.28, P < .001) compared to patients aged <65 years. In patients undergoing a primary anastomosis with diverting loop ileostomy, 30-day morbidity was lower only in the cohort aged ≥80 years (OR 2.63, P = .04). Readmission rates were similar across age groups within each procedure cohort. Comparing the 2 procedures, readmission rates in patients aged 65-79 years who underwent a Hartmann procedure were lower than those that underwent a primary anastomosis with diverting loop ileostomy (OR 2.43, P = .001). In patients aged ≥80 years, readmission rates were lower in patients who underwent a primary anastomosis with diverting loop ileostomy (OR 0.12, P = .04). Thirty-day mortality was also lower in patients aged ≥80 years if they underwent a primary anastomosis with diverting loop ileostomy (OR 0.15, P = .03) but similar for patients aged 65-79 years (OR 0.81, P = .70).
In patients undergoing a Hartmann procedure emergently for diverticulitis, mortality is higher in older patients. Patients aged ≥ 80 years had increased mortality if they underwent a Hartmann procedure compared to a primary anastomosis with diverting ileostomy; however, readmission rates vary with procedure performed. Careful consideration of age should be taken into account when operating emergently for diverticulitis.
比较老年人群急性憩室炎急诊手术治疗的效果。
回顾性多机构数据库队列分析。
美国外科医师学会国家外科质量改进项目（ACS NSQIP）和NSQIP结肠切除术靶向数据库。
将美国外科医师学会国家外科质量改进项目结肠切除术靶向数据库与主要参与使用文件合并，以识别因急性憩室炎接受急诊哈特曼手术或带分流襻回肠造口术的一期吻合术的成年患者。患者被分为年龄组（<65岁、65 - 79岁、≥80岁），并使用多变量回归比较包括死亡率、发病率和再入院率在内的主要术后结局。
共识别出6091例患者。多变量分析显示，与<65岁的患者相比，65 - 79岁（优势比[OR] 2.39，P <.001）和≥80岁（OR 6.28，P <.001）接受哈特曼手术的患者30天死亡率更高。在接受带分流襻回肠造口术的一期吻合术的患者中，仅≥80岁年龄组的30天发病率较低（OR 2.63，P =.04）。每个手术组内各年龄组的再入院率相似。比较这两种手术，65 - 79岁接受哈特曼手术的患者的再入院率低于接受带分流襻回肠造口术的一期吻合术的患者（OR 2.43，P =.001）。在≥80岁的患者中，接受带分流襻回肠造口术的一期吻合术的患者再入院率较低（OR 0.12，P =.04）。≥80岁的患者如果接受带分流襻回肠造口术的一期吻合术，30天死亡率也较低（OR 0.15，P =.03），但65 - 79岁的患者相似（OR 0.81，P =.70）。
因憩室炎急诊接受哈特曼手术的患者中，老年患者死亡率更高。与带分流回肠造口术的一期吻合术相比，≥80岁的患者接受哈特曼手术时死亡率增加；然而，再入院率因所进行的手术而异。急诊进行憩室炎手术时应仔细考虑年龄因素。
