Department of Surgery, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
J Pediatr Surg. 2023 Dec;58(12):2337-2342. doi: 10.1016/j.jpedsurg.2023.07.012. Epub 2023 Jul 25.
In pediatric ulcerative colitis (UC), surgery is often postponed until disease is life-threatening or refractory to immune suppression. In these settings, diverting ileostomy (DI) is theorized to have a protective effect on the new anastomosis. However, analyses have been performed only in single-institution series and the true impact of performing DI at the time of IPAA on postoperative outcomes is unclear.
We performed a retrospective cohort study using claims data from the International Business Machines (IBM) MarketScan® database. Patients were sorted to the DI group if they carried a CPT code for ostomy closure within 6 months of index procedure. We examined demographics, preoperative risk factors, and performed regression analysis to compare 30-day postoperative outcomes between groups.
We identified 317 patients ≤18yo that underwent IPAA procedure and met inclusion criteria from 2000 to 2019. Of these, 238 patients were assigned to the IPAA + DI cohort and 79 patients were assigned to the IPAA cohort. Adverse outcomes were comparable between cohorts. Surgical site infection (SSI) rates between IPAA and IPAA + DI were 10.1 vs. 11.3% (p = 0.67). Rates of intra-abdominal drainage procedures were 3.8 vs. 2.1% (p = 0.39). The rates of 30-day readmissions were 16.5 vs. 19.3% (p = 0.39). Creation of a DI was not associated with higher odds of 30-day readmission (OR = 1.4, p = 0.31).
Creating a DI necessitates an additional surgery for closure and is not associated with decreased adverse outcomes. There is still a role for multicenter studies to define which patient populations may benefit from diversion.
Retrospective comparative study.
Level III.
在小儿溃疡性结肠炎（UC）中，手术通常会被推迟到疾病危及生命或对免疫抑制药物产生抗药性时才进行。在这些情况下，预防性回肠造口术（DI）被认为对新吻合口具有保护作用。然而，之前的分析仅在单机构系列中进行，在进行回肠直肠吻合术（IPAA）时同时行 DI 对术后结果的真正影响尚不清楚。
我们使用来自国际商业机器公司（IBM）市场扫描（IBM MarketScan）数据库的索赔数据进行了回顾性队列研究。如果患者在索引手术的 6 个月内有造口关闭的 CPT 代码，则将其归入 DI 组。我们检查了人口统计学、术前危险因素，并进行了回归分析，以比较两组患者的 30 天术后结果。
我们从 2000 年至 2019 年确定了 317 名接受 IPAA 手术且符合纳入标准的≤18 岁患者。其中，238 名患者被分配到 IPAA+DI 组，79 名患者被分配到 IPAA 组。两组的不良结局相当。IPAA 和 IPAA+DI 之间的手术部位感染（SSI）发生率分别为 10.1%和 11.3%（p=0.67）。腹腔引流术的发生率分别为 3.8%和 2.1%（p=0.39）。30 天再入院率分别为 16.5%和 19.3%（p=0.39）。创建 DI 与 30 天再入院的几率增加无关（OR=1.4，p=0.31）。
创建 DI 需要进行额外的手术来关闭造口，并且不会导致不良后果减少。仍然需要进行多中心研究来确定哪些患者群体可能从引流中受益。
回顾性比较研究。
III 级。
