Gynecological Surgery, Advent Health Winter Park Hospital, Winter Park, FL, USA.
Health Economics and Outcomes Research, Astellas Pharma Europe B.V., Leiden, The Netherlands.
Adv Ther. 2023 Jul;40(7):3169-3185. doi: 10.1007/s12325-023-02515-z. Epub 2023 May 25.
Preoperative ureteral catheterization/stenting (stenting) and intraoperative diagnostic cystoscopy (cystoscopy) may help prevent or identify intraoperative ureteral injuries (IUIs) during abdominopelvic surgery. In order to provide a comprehensive, single source of data for health care decision makers, this study aimed to catalog the incidence of IUI and rates of stenting and cystoscopy across a wide spectrum of abdominopelvic surgeries.
We conducted a retrospective cohort analysis of United States (US) hospital data (October 2015-December 2019). IUI rates and stenting/cystoscopy use were investigated for gastrointestinal, gynecological, and other abdominopelvic surgeries. IUI risk factors were identified using multivariable logistic regression.
Among approximately 2.5 million included surgeries, IUIs occurred in 0.88% of gastrointestinal, 0.29% of gynecological, and 1.17% of other abdominopelvic surgeries. Aggregate rates varied by setting and for some surgery types were higher than previously reported, especially in certain higher-risk colorectal procedures. Prophylactic measures were generally employed at a relatively low frequency, with cystoscopy used in 1.8% of gynecological procedures and stenting used in 5.3% of gastrointestinal and 2.3% of other abdominopelvic surgeries. In multivariate analyses, stenting and cystoscopy use, but not surgical approach, were associated with a higher risk of IUI. Risk factors associated with stenting or cystoscopy, as well as those for IUI, largely mirrored the variables reported in the literature, including patient demographics (older age, non-White race, male sex, higher comorbidity), practice settings, and established IUI risk factors (diverticulitis, endometriosis).
Use of stenting and cystoscopy largely varied by surgery type, as did rates of IUI. The relatively low use of prophylactic measures suggests there may be an unmet need for a safe, convenient method of injury prophylaxis in abdominopelvic surgeries. Development of new tools, technology, and/or techniques is needed to help surgeons identify the ureter and avoid IUI and the resulting complications.
术前输尿管置管/支架（支架）和术中诊断性膀胱镜检查（膀胱镜检查）可能有助于预防或识别腹盆部手术中的术中输尿管损伤（IUI）。为了为医疗保健决策者提供全面的单一来源数据，本研究旨在对广泛的腹盆部手术中 IUI 的发生率以及支架和膀胱镜检查的使用率进行分类。
我们对美国（美国）医院数据（2015 年 10 月至 2019 年 12 月）进行了回顾性队列分析。研究了胃肠道、妇科和其他腹盆部手术中 IUI 的发生率以及支架/膀胱镜检查的使用情况。使用多变量逻辑回归确定 IUI 的危险因素。
在大约 250 万例纳入手术中，胃肠道手术中发生 IUI 的比例为 0.88%，妇科手术中为 0.29%，其他腹盆部手术中为 1.17%。综合发生率因手术类型和环境而异，某些手术类型的发生率高于先前报道的，尤其是某些高风险的结直肠手术。预防性措施的使用频率一般较低，妇科手术中仅 1.8%使用膀胱镜检查，胃肠手术中 5.3%和其他腹盆部手术中 2.3%使用支架。在多变量分析中，支架和膀胱镜检查的使用与 IUI 的风险增加相关，但手术方法与 IUI 的风险增加无关。与支架或膀胱镜检查相关的危险因素以及与 IUI 相关的危险因素在很大程度上与文献中报告的变量相匹配，包括患者人口统计学特征（年龄较大、非白种人、男性、合并症较多）、实践环境和已确立的 IUI 危险因素（憩室炎、子宫内膜异位症）。
支架和膀胱镜检查的使用在很大程度上因手术类型而异，IUI 的发生率也是如此。预防性措施的使用相对较低，表明在腹盆部手术中可能存在对安全、方便的损伤预防方法的未满足需求。需要开发新的工具、技术和/或技术来帮助外科医生识别输尿管并避免 IUI 及其带来的并发症。
