标准化管理下急诊剖腹手术后 1 年的死亡率：来自瑞典 SMASH 研究的结果。

One-year mortality rates after standardized management for emergency laparotomy: results from the Swedish SMASH study.

机构信息

Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.

Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.

出版信息

BJS Open. 2024 Jan 3;8(1). doi: 10.1093/bjsopen/zrad133.

DOI:10.1093/bjsopen/zrad133

PMID:38284401

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10823779/

Abstract

BACKGROUND

Patients who require an emergency laparotomy suffer from high mortality and morbidity rates. Studies have shown that the standardization of perioperative management reduces complications in the short term. The aim of the present study was to report long-term mortality rates for the SMASH (Standardized perioperative Management of patients operated with acute Abdominal Surgery in a High-risk and emergency setting) study, as well as short- and long-term outcomes for different age groups within the SMASH study.

METHODS

A prospective intervention study was introduced in 2018, with the aim of investigating the introduction of a standardized protocol for emergency laparotomy. For 42 months, intervention patients were managed according to the protocol and outcomes were then compared with those of historical controls.

RESULTS

A total of 1344 unique patients were included (681 in the intervention group and 663 in the control group). The 90-day mortality rate was 14.1 per cent in the intervention group and 20.8 per cent in the control group (P = 0.002) and the 1-year mortality rate in adjusted analyses was 19.7 and 27.8 per cent respectively (P =< 0.001). An age-related subgroup analysis showed that the oldest patients (76 years and older, 260 in the intervention group and 240 in the control group) had a 1-year mortality rate of 29.6 and 43.8 per cent respectively (P = 0.004) and a mean duration of hospital stay of 9.9 and 11.6 days respectively (P = 0.027). Among older adults (61-75 years), the mean duration of hospital stay was 11.7 days in the intervention group compared with 15.1 days in the control group (P = 0.009) and the mean duration of ICU care was reduced to 4.49 days compared with 7.29 days (P = 0.046).

CONCLUSION

The standardized protocol associated with an emergency laparotomy appears to be beneficial, even in the long term. For elderly patients, it appears to reduce mortality rates and the durations of hospital stay and ICU care.

摘要

背景

需要进行紧急剖腹手术的患者死亡率和发病率都很高。研究表明，围手术期管理的标准化可以减少短期并发症。本研究旨在报告 SMASH（高危和紧急情况下急性腹部手术患者标准化围手术期管理）研究的长期死亡率，以及 SMASH 研究中不同年龄组的短期和长期结果。

方法

2018 年引入了一项前瞻性干预研究，旨在研究引入标准化剖腹手术方案。在 42 个月的时间里，干预组患者按照方案进行管理，然后将结果与历史对照组进行比较。

结果

共纳入 1344 例独特患者（干预组 681 例，对照组 663 例）。干预组 90 天死亡率为 14.1%，对照组为 20.8%（P=0.002），调整分析后 1 年死亡率分别为 19.7%和 27.8%（P<0.001）。年龄相关亚组分析显示，最年长的患者（76 岁及以上，干预组 260 例，对照组 240 例）1 年死亡率分别为 29.6%和 43.8%（P=0.004），住院时间分别为 9.9 天和 11.6 天（P=0.027）。在老年患者（61-75 岁）中，干预组的平均住院时间为 11.7 天，对照组为 15.1 天（P=0.009），ICU 护理时间也从 7.29 天缩短至 4.49 天（P=0.046）。