择期和急诊结直肠手术后主要并发症再次手术后的抢救失败：一项基于人群的多中心队列研究。

Failure to rescue after reoperation for major complications of elective and emergency colorectal surgery: A population-based multicenter cohort study.

机构信息

Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: http://www.twitter.com/LauraKoskenvuo.

出版信息

Surgery. 2022 Oct;172(4):1076-1084. doi: 10.1016/j.surg.2022.04.052. Epub 2022 Aug 1.

DOI:10.1016/j.surg.2022.04.052

PMID:35927079

Abstract

BACKGROUND

As surgical complications inevitably occur, minimizing the failure-to-rescue rate is of paramount interest. Most of the failure-to-rescue research in colorectal surgery has previously focused on elective surgery and anastomotic dehiscence. The aim of this study was to characterize and compare the major postoperative complications demanding reoperation after elective versus emergency colorectal surgery, and to the identify risk factors for failure-to-rescue.

METHODS

In this population-based retrospective multicenter cohort study, adult patients undergoing a reoperation for colorectal surgery complication between 2006 and 2017 in 10 hospitals were included. The data were manually extracted. Failure-to-rescue was defined as 90-day mortality after the reoperation.

RESULTS

In total, 14,290 patients underwent index colorectal resection, of which 862 (5.8%) underwent emergency reoperation within 30 days (438 [4.3%] after elective, 424 [10.4%] after emergency index operation, P < .001). The failure-to-rescue overall rate was 17.4% (8.0% after elective vs 27.1% after emergency index operation, P < .001). The 4 most common complications were anastomotic dehiscence (36.6%, 316 patients), fascial rupture (23.5%, 203 patients), intra-abdominal bleeding (15.3%, 131 patients), and bowel obstruction (10.2%, 88 patients). The majority (640 patients, 74.2%) had 1 of these complications; 261 patients (30.3%) had multiple complications. In multivariable analyses, the only possibly preventable independent risk factor for failure-to-rescue was perioperative organ failure at the time of reoperation.

CONCLUSION

Major complications requiring reoperation occur more than twice as often after emergency surgery and have a higher failure-to-rescue rate of >3× compared with elective surgery. The 4 most common complication types constitute three-fourths of the complications, providing a target for quality improvement.

摘要

背景

由于手术并发症不可避免，因此将抢救失败率降至最低至关重要。以前大多数关于结直肠手术抢救失败的研究都集中在择期手术和吻合口裂开上。本研究旨在描述和比较择期与急诊结直肠手术后需要再次手术的主要术后并发症，并确定抢救失败的危险因素。

方法

在这项基于人群的回顾性多中心队列研究中，纳入了 2006 年至 2017 年期间在 10 家医院因结直肠手术并发症而再次手术的成年患者。数据通过人工提取。抢救失败定义为再次手术后 90 天内的死亡率。

结果

共 14290 例患者接受了指数结直肠切除术，其中 862 例（5.8%）在 30 天内行急诊再次手术（438 例[4.3%]在择期手术，424 例[10.4%]在急诊手术），P<0.001）。抢救失败的总发生率为 17.4%（择期手术为 8.0%，急诊手术为 27.1%，P<0.001）。最常见的 4 种并发症是吻合口裂开（36.6%，316 例）、筋膜破裂（23.5%，203 例）、腹腔内出血（15.3%，131 例）和肠梗阻（10.2%，88 例）。大多数患者（640 例，74.2%）有一种并发症；261 例患者（30.3%）有多种并发症。多变量分析显示，再次手术时围手术期器官衰竭是唯一可能预防的独立抢救失败危险因素。