Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.
Department of Surgical Education, Division of Medical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA.
Am Surg. 2022 Sep;88(9):2182-2193. doi: 10.1177/00031348221101510. Epub 2022 May 19.
We aim to identify patient cohorts where laparoscopy can be safely utilized with comparable or better outcomes to laparotomy among patients with single penetrating LUQ injuries with a hypothesis that compared to laparotomy, laparoscopy may be associated with equal or improved outcomes of low injury severity patients.
Retrospective review of the ACS-TQP-Participant Use File 2016-2019 dataset. Patients with single LUQ penetrating injuries were included. Primary outcome was risk-adjusted in-hospital mortality. Secondary outcomes included: risk-adjusted complication rates, hospital length-of-stay (H-LOS), and ICU-LOS. Descriptive statistics and multivariable regression with reliability adjustments to account for variations in practice were performed.
Of 4149 patients analyzed, 3571 (86.1%) underwent laparotomy, 489 (11.8%) underwent laparoscopy, and 89 (2.1%) underwent laparoscopy-to-laparotomy conversion. Adjusted mortality rates were not significantly different among all study cohorts (P > .05). Compared to laparoscopy, adjusted odds of complications were 4.3-fold higher for all patients who underwent laparotomy and 4-fold higher for laparoscopy-to-laparotomy (LtL) patients (P < .05). Diaphragmatic injuries were associated with significantly increased odds of undergoing LtL, whereas sustaining a colonic injury, gastric injury, hepatic injury, or requiring PRBC transfusions were associated with significantly increased odds of undergoing laparotomy (P < .05). H-LOS (days) was significantly longer for patients who underwent laparotomy compared to laparoscopy (3.9 ± 4.0 vs. 10.8 ± 13.4, P < .0001).
Laparoscopy may be considered a viable alternative to laparotomy for hemodynamically stable adult patients with single penetrating LUQ injuries of low injury burden validating our hypothesis. Laparoscopy may be less safe for patients with associated diaphragmatic, colonic, or hepatic injuries.
我们旨在确定在因单一穿透性左上腹部损伤而就诊的患者中，与剖腹术相比，腹腔镜手术可以安全实施且具有相似或更好的结局的患者群体。我们的假设是，与剖腹术相比，腹腔镜手术可能与低损伤严重度患者的同等或改善结局相关。
回顾性分析 2016 年至 2019 年 ACS-TQP-参与者使用文件数据集。纳入了单一 LUQ 穿透性损伤的患者。主要结局是风险调整后的院内死亡率。次要结局包括：风险调整后的并发症发生率、住院时间（H-LOS）和 ICU 入住时间（ICU-LOS）。进行了描述性统计和多变量回归分析，并进行了可靠性调整以考虑实践中的变化。
在分析的 4149 例患者中，3571 例（86.1%）接受了剖腹术，489 例（11.8%）接受了腹腔镜检查，89 例（2.1%）进行了腹腔镜到剖腹术的转换。所有研究队列的调整死亡率无显著差异（P>.05）。与腹腔镜相比，所有接受剖腹术的患者的调整后并发症发生几率是腹腔镜的 4.3 倍，接受腹腔镜到剖腹术转换（LtL）的患者的调整后并发症发生几率是腹腔镜的 4 倍（P<.05）。膈肌损伤与 LtL 的发生几率显著增加相关，而结肠损伤、胃损伤、肝损伤或需要 PRBC 输血与剖腹术的发生几率显著增加相关（P<.05）。与腹腔镜相比，接受剖腹术的患者的 H-LOS（天数）显著延长（3.9 ± 4.0 与 10.8 ± 13.4，P<.0001）。
对于低损伤负荷的单一穿透性左上腹部损伤的血流动力学稳定的成年患者，腹腔镜手术可能被视为剖腹术的可行替代方案，验证了我们的假设。腹腔镜手术对于伴有膈肌、结肠或肝损伤的患者可能不太安全。
