The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, United States.
Clin Res Hepatol Gastroenterol. 2024 Aug;48(7):102391. doi: 10.1016/j.clinre.2024.102391. Epub 2024 Jun 2.
Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus.
National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression.
There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37-2.038, p < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85-2.536, p < 0.01), sepsis (aOR=1.31, 95 CI=1.107-1.551, p < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269-1.626, p < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23-4.411, p < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007-1.42, p = 0.04). Moreover, DFS patients had a longer length of stay (p = 0.01).
DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.
结肠扭转是肠梗阻的常见原因，手术是其明确的治疗方法。功能状态通常与术后不良结局相关，但它对扭转性结肠切除术的影响仍未得到充分探讨。本研究旨在分析功能状态对扭转性结肠切除术 30 天结局的影响。
利用 2012 年至 2022 年国家手术质量改进计划（NSQIP）的靶向结肠切除术数据库。仅纳入以扭转为主要手术指征的患者。通过多变量逻辑回归，比较依赖功能状态（DFS）和独立功能状态（IFS）患者的 30 天术后结局，调整人口统计学、基线特征、术前准备、手术指征和手术方法。
共纳入 1476 例 DFS（945 例部分 DFS 和 531 例完全 DFS）和 8824 例（85.67%）IFS 患者，行扭转性结肠切除术。多变量分析后，DFS 患者的死亡率（aOR=1.671，95%CI=1.37-2.038，p<0.01）、肺部并发症（aOR=2.166，95%CI=1.85-2.536，p<0.01）、脓毒症（aOR=1.31，95%CI=1.107-1.551，p<0.01）、术后长时间禁食（NPO）或经鼻胃管（NGT）使用（aOR=1.436，95%CI=1.269-1.626，p<0.01）、出院非居家（aOR=3.774，95%CI=3.23-4.411，p<0.01）和 30 天再入院（aOR=1.196，95%CI=1.007-1.42，p=0.04）风险较高。此外，DFS 患者的住院时间较长（p=0.01）。
DFS 是扭转性结肠切除术后死亡率和并发症增加的独立危险因素。鉴于 DFS 患者与患有结肠扭转的患者之间存在很大的重叠，这些发现有助于这些患者的术前风险评估和术后护理。
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