当代美国术前营养不良与食管裂孔疝修补术结果的相关性。
Contemporary association of preoperative malnutrition and outcomes of hiatal hernia repairs in the United States.
机构信息
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA.
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, CA; David Geffen School of Medicine, University of California, Los Angeles, CA.
出版信息
Surgery. 2023 Aug;174(2):301-306. doi: 10.1016/j.surg.2023.04.013. Epub 2023 May 20.
BACKGROUND
Hypoalbuminemia has been used as a surrogate for malnutrition and is associated with worse postoperative outcomes across major operations. Because patients with hiatal hernia often have inadequate caloric intake, we examined the association of serum albumin levels with outcomes after hiatal hernia repair.
METHODS
Adults undergoing elective and non-elective hiatal hernia repair via any approach were tabulated from the 2012 to 2019 National Surgical Quality Improvement Program. Patients were stratified into the Hypoalbuminemia cohort if serum albumin <3.5 mg/dL using restricted cubic spline analysis. Major adverse events were defined as a composite of all-cause mortality and major complications per the American College of Surgeons National Surgical Quality Improvement Program risk calculator. Entropy balancing was used to adjust for intergroup differences. Multivariable regression models were then constructed to assess the association of preoperative albumin with major adverse events, postoperative length of stay, and 30-day readmission.
RESULTS
Of 23,103 patients, 11.7% comprised the Hypoalbuminemia cohort. The Hypoalbuminemia group was older, less commonly of White race, and less likely to have an independent functional status than others. They were also more likely to undergo inpatient, non-elective surgery via laparotomy. After entropy balancing and adjustment, hypoalbuminemia remained associated with increased odds of major adverse events and multiple complications and longer adjusted postoperative length of stay. There was no significant difference in adjusted odds of readmission.
CONCLUSION
We used a quantitative methodology to establish a serum albumin threshold of 3.5 mg/dL associated with increased adjusted odds of major adverse events, increased postoperative length of stay, and postoperative complications after hiatal hernia repair. These results may guide preoperative nutrition supplementation.
背景
低白蛋白血症常被用作营养不良的替代指标，与大多数手术后的不良预后相关。由于食管裂孔疝患者通常存在热量摄入不足的情况，我们研究了血清白蛋白水平与食管裂孔疝修补术后结局的关系。
方法
从 2012 年至 2019 年全国外科质量改进计划中列出了通过任何途径择期和非择期行食管裂孔疝修补术的成年人。使用限制立方样条分析，将血清白蛋白<3.5mg/dL 的患者分为低白蛋白血症组。主要不良事件定义为美国外科医师学会全国外科质量改进计划风险计算器所定义的全因死亡率和主要并发症的复合事件。采用熵平衡法调整组间差异。然后构建多变量回归模型，以评估术前白蛋白与主要不良事件、术后住院时间和 30 天再入院之间的关系。
结果
在 23103 例患者中，11.7%为低白蛋白血症组。低白蛋白血症组年龄较大，白人种族比例较低，独立功能状态的可能性较小。他们也更有可能通过剖腹手术进行住院、非择期手术。经过熵平衡和调整后，低白蛋白血症与主要不良事件和多种并发症的发生几率增加以及调整后术后住院时间延长相关。调整后再入院的几率无显著差异。
结论
我们使用定量方法确定了 3.5mg/dL 的血清白蛋白阈值，与食管裂孔疝修补术后主要不良事件、调整后术后住院时间延长和术后并发症的发生率增加相关。这些结果可能指导术前营养补充。
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