Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Surg Infect (Larchmt). 2022 Aug;23(6):525-531. doi: 10.1089/sur.2021.309.
It is unknown whether having multiple acute care surgery (ACS) procedures performed in one admission confers additional risk. We hypothesized that having multiple procedures (for example, hernia repair plus bowel resection) would be associated with higher mortality. We identified all 2017 National Inpatient Sample admissions with ACS procedures including: colon, small bowel/appendix (SB), hernia, adhesiolysis, peptic ulcer procedures, gallbladder, debridement, other laparotomy, other laparoscopy. The total number of procedures for each admission and common dyad (two-procedure) and triad (three-procedure) combinations were identified. Logistic regression estimated the odds of in-hospital mortality for increasing procedure count and specific dyad and triad combinations, using patients with one procedure as the reference. A total of 216,317 ACS patients (median age, 57, interquartile range [IQR], 43-70; 50.6% female) were included; 2.8% died. Patients with multiple procedures were more likely to die than patients with one procedure (7.4% vs. 1.9%). An increasing number of procedures was associated with higher odds of death (two procedures: odds ratio [OR], 3.0; 95% confidence interval [CI], 2.9-3.2] to six or more procedures, OR, 9.5; 95% CI, 4.9-18.5); having more than three procedures was associated with at least fivefold higher odds of death. Specific dyads/triads were associated with particularly high risk of mortality, including ulcer/laparotomy (OR, 15.5; 95% CI, 13.7-17.5) and laparotomy/SB (OR, 8.31; 95% CI, 5.15-13.40). Multiple ACS procedures in one hospitalization confer increased odds of in-hospital mortality. This knowledge enables the ACS providers to better counsel patients by giving more specific expectations regarding mortality based on the number of procedures required or anticipated during an admission.
尚不清楚一次住院期间进行多次急性护理手术（ACS）是否会带来额外的风险。我们假设进行多次手术（例如，疝修补术加肠切除术）与更高的死亡率相关。我们确定了所有 2017 年国家住院患者样本中包含 ACS 手术的入院患者，包括：结肠、小肠/阑尾（SB）、疝、粘连松解术、消化性溃疡手术、胆囊、清创术、其他剖腹手术、其他腹腔镜手术。确定了每个入院患者的总手术次数和常见的双手术（两手术）和三联手术（三手术）组合。使用只有一个手术的患者作为参考，使用逻辑回归估计手术次数增加以及特定双手术和三联手术组合的住院死亡率的几率。共有 216317 名 ACS 患者（中位数年龄为 57 岁，四分位距[IQR]为 43-70；50.6%为女性），其中 2.8%死亡。与只有一个手术的患者相比，进行多个手术的患者更有可能死亡（7.4%比 1.9%）。手术次数增加与死亡几率增加相关（两个手术：比值比[OR]，3.0；95%置信区间[CI]，2.9-3.2]到六个或更多手术，OR，9.5；95%CI，4.9-18.5）；进行三个以上手术与死亡几率至少增加五倍相关。特定的双联/三联手术与特别高的死亡率相关，包括溃疡/剖腹手术（OR，15.5；95%CI，13.7-17.5）和剖腹手术/SB（OR，8.31；95%CI，5.15-13.40）。一次住院期间进行多次 ACS 手术会增加住院期间死亡率的几率。这一认识使 ACS 提供者能够更好地为患者提供咨询，根据在一次住院期间需要或预期的手术次数，更具体地告知患者死亡率的预期。
