Seeto Alexander H, Nabi Hajir, Burstow Matthew J, Lancashire Raymond P, Grundy Joshua, Gillespie Christopher, Nguyen Khuong, Naidu Sanjeev, Chua Terence C
Department of General Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
ANZ J Surg. 2023 Apr;93(4):926-931. doi: 10.1111/ans.18091. Epub 2022 Oct 6.
Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals.
Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications.
During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) (P = 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P = 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P < 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P = 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47).
The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.
与择期结直肠手术相比，急诊结直肠手术往往预后较差。本研究评估了两家大城市医院中接受急诊和择期结直肠切除术患者的发病率和死亡率。
回顾性分析2018年4月至2020年7月期间两家机构的患者。收集基线、手术和术后参数，以便在急诊和择期手术组之间进行比较分析。进行二元逻辑回归以确定术后并发症的独立预测因素。
在研究期间，454例患者接受了结直肠切除术，其中135例为急诊病例（29.74%），319例为择期病例（70.26%）。与择期切除术相比，接受急诊切除术的患者美国麻醉医师协会（ASA）评分III至IV级的比例更高（53.33%对38.56%）（P = 0.004）。急诊组和择期组的死亡率相似（1.48%对0.63%，P = 0.369）。接受急诊切除术的患者总体并发症发生率更高（64.44%对36.68%，P < 0.001），但两组之间的主要并发症发生率相似（12.59%对10.34%，P = 0.484）。术后并发症的独立预测因素包括急诊手术（比值比（OR）2.77，95%置信区间（CI）：1.66至4.61）和ASA评分III至IV级（OR 2.87，95%CI：1.84至4.47）。
接受急诊结直肠切除术的患者总体并发症发生率更高，然而，两组之间的主要并发症发生率和死亡率相似。较高的并发症发生率反映了合并症较多患者的疾病病理进展。
