干预措施预防回肠造口术患者术后肠梗阻的概念验证。

Proof-of-concept for intervention to prevent post-operative ileus in patients undergoing ileostomy formation.

作者信息

Greenberg Anya L, Kelly Yvonne M, Sarin Ankit, Varma Madhulika G

机构信息

School of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.

出版信息

Perioper Med (Lond). 2022 Jul 12;11(1):25. doi: 10.1186/s13741-022-00257-0.

DOI:10.1186/s13741-022-00257-0

PMID:35818058

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9275170/

Abstract

BACKGROUND

Preventing post-operative ileus (POI) is important given its associated morbidity and increased cost of care. The authors' prior work showed that POI in patients with newly created ileostomies is associated with a post-operative day (POD) 2 net fluid balance of > + 800 mL. The purpose of this study was to conduct an initial assessment of the efficacy of a pilot intervention.

METHODS

This is a single-institution, pre-post-intervention, proof-of-concept study conducted on the Colorectal Surgery service at the University of California, San Francisco. The study included 58 procedures with ileostomy formation by board-certified colorectal surgeons between August 13, 2020 and June 1, 2021. The intervention included three adjustments to the standard Enhanced Recovery After Surgery protocol: addition of diuresis, delay in advancement to solid food, and earlier stoma intubation. Demographics, intraoperative factors, post-operative fluid balance, and outcomes (POI, post-procedure length of stay [LOS], hospitalization cost, and re-admissions) were compared between patients pre- and post-intervention.

RESULTS

Eight (13.8%) of the 58 procedures in the intervention period were associated with POI vs. a baseline POI rate of 32.6% (p = 0.004). Compared to patients without intervention, those with intervention had 67% less odds of POI (OR 0.33, 95% CI 0.15-0.73, p = 0.01). This difference remained significant when adjusted for age, gender, body mass index, procedure duration, and operative approach (adjusted OR 0.32, 95% CI 0.14-0.72, p = 0.01). Average POD2 stoma output was 0.3 L greater (1.1 L vs. 0.8L; p < 0.001) and net fluid balance was 1.8 L lower (+ 0.3 L vs. + 2.1 L; p < 0.00001) for these 58 cases. Average post-procedure LOS was 1.9 days lower (5.3 vs. 7.2 days, p < 0.001) and direct cost was $5561 lower ($21,652 vs. $27,213, p = 0.004), with no difference in 30-day readmissions (p = 0.43).

CONCLUSIONS

This pilot intervention shows promise for reduction in POI in patients with newly created ileostomies. Additional assessment is needed to confirm these initial findings.

摘要

背景

鉴于术后肠梗阻（POI）会带来相关发病率并增加护理成本，预防POI至关重要。作者之前的研究表明，新建回肠造口术患者的POI与术后第2天净液体平衡> +800 mL相关。本研究的目的是对一项试点干预措施的疗效进行初步评估。

方法

这是一项在加利福尼亚大学旧金山分校结直肠外科进行的单机构、干预前后、概念验证研究。该研究纳入了2020年8月13日至2021年6月1日期间由获得委员会认证的结直肠外科医生进行的58例回肠造口术。干预措施包括对标准的术后加速康复方案进行三项调整：增加利尿、延迟固体食物摄入推进以及更早的造口插管。对干预前后患者的人口统计学、术中因素、术后液体平衡和结局（POI、术后住院时间[LOS]、住院费用和再入院情况）进行了比较。

结果

干预期间58例手术中有8例（13.8%）与POI相关，而基线POI发生率为32.6%（p = 0.004）。与未干预的患者相比，接受干预的患者发生POI的几率低67%（OR 0.33，95% CI 0.15 - 0.73，p = 0.01）。在对年龄、性别、体重指数、手术持续时间和手术方式进行调整后，这种差异仍然显著（调整后的OR 0.32，95% CI 0.14 - 0.72，p = 0.01）。这58例患者术后第2天造口平均排出量多0.3 L（1.1 L对0.8 L；p < 0.001），净液体平衡低1.8 L（+0.3 L对+2.1 L；p < 0.00001）。术后平均住院时间短1.9天（5.3天对7.2天，p < 0.001），直接成本低5561美元（21,652美元对27,213美元，p = 0.004），30天再入院率无差异（p = 0.43）。