乙状结肠扭转：评估识别策略和当代多中心结局。
Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes.
机构信息
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA.
Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA.
出版信息
Am J Surg. 2023 Jan;225(1):191-197. doi: 10.1016/j.amjsurg.2022.07.025. Epub 2022 Aug 1.
BACKGROUND
There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV.
METHOD
Using an automated search for patients with 'volvulus' in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes.
RESULTS
Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes.
CONCLUSION
Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery.
背景
非流行地区关于乙状结肠扭转（SV）的流行病学数据有限。因此，我们进行了一项多中心研究，报告当代结果，并评估基于文献的方法，该方法通过诊断和程序代码配对来识别 SV。
方法
我们使用系统中 2011 年至 2021 年的“扭转”自动搜索，查阅电子病历以明确诊断，自动复制三种识别 SV 的策略，并检索 6 个月的结果。
结果
在 895 名患者中，有 109 名患有 SV。基于文献的策略很难识别 SV。在首次入院时，患者接受单纯内镜复位（33%）、紧急（16.5%）、半择期（34%）或择期（16.5%）手术。单纯内镜复位的复发率较高，延迟手术与不良结局相关。
结论
基于文献的识别 SV 的策略存在分类错误的偏倚，这会影响患者咨询。在这项大型研究中，尽管早期手术可改善结局，但三分之一的患者在首次就诊时未接受手术。
Zotero 插件