Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland.
Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland.
Pol Przegl Chir. 2024 Apr 3;96(4):44-49. doi: 10.5604/01.3001.0054.4604.
<b>Introduction:</b> Loop ileostomy reversal (LIR) procedure is still associated with a relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. SSI leads to prolonged hospital stays, delays the adjuvant therapy, and increases hospital costs.<b>Aim:</b> The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.<b>Material and methods:</b> A single-center retrospective analysis was conducted in a tertiary reference center. Finally, 65 patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled in the study. Data were collected retrospectively based on the available medical charts. The study group comprised 23 women (35%) and 42 men (65%) with a mean age of 48.9 14.5 years and a mean body mass index of 24.3 4.9 kg/m<sup>2</sup> . The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n = 42; 64.6%).<b>Results:</b> The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which influenced e.g. hospitalization after surgery, the need for antibiotic therapy, or C-reactive protein (CRP) values. Nine patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI, hospital stay exceeded 13 days compared to almost 6 days in the group without SSI (P = 0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (P = 0.01). The type of intestinal anastomosis had a significant impact on the operative time (P = 0.0011) and the time of hospital stay after surgery (P = 0.04).<b>Conclusions:</b> Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor increasing the risk of other postoperative complications and significantly increasing the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities which make patients more likely to develop SSI, CRP increase, or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.
<b>引言：</b>回肠袢式造口还纳术（LIR）后仍存在相对较高的并发症风险。手术部位感染（SSI）是这群患者最常见的并发症。SSI 导致住院时间延长、辅助治疗延迟和住院费用增加。<b>目的：</b>本研究旨在分析回肠袢式造口还纳术后患者发生 SSI 的危险因素。<b>材料与方法：</b>在一家三级参考中心进行了单中心回顾性分析。最终，纳入了 2018 年至 2022 年间进行的 65 例回肠袢式造口还纳术患者。数据根据现有病历进行回顾性收集。研究组包括 23 名女性（35%）和 42 名男性（65%），平均年龄为 48.9 14.5 岁，平均体重指数为 24.3 4.9kg/m<sup>2</sup> 。指数手术的主要适应证为溃疡性结肠炎（33%）和结直肠癌（29%）。首选进行手工吻合（n=42；64.6%）。<b>结果：</b>本研究评估的最重要参数是手术部位感染的诊断，这会影响例如手术后的住院时间、抗生素治疗的需求或 C 反应蛋白（CRP）值。9 名患者（13.8%）在住院期间被诊断为 SSI（超过 86%的无 SSI 患者）。在 SSI 组中，住院时间超过 13 天，而无 SSI 组几乎为 6 天（P=0.00009）。手术时间与抗生素治疗的引入具有统计学显著相关性（P=0.01）。肠吻合术的类型对手术时间（P=0.0011）和术后住院时间（P=0.04）有显著影响。<b>结论：</b>分析的大多数临床因素直接关系到术后住院时间的延长。住院时间是增加术后其他并发症风险和显著增加住院费用的独立且不可否认的因素。另一个对术后治疗有较大临床影响的因素是合并症的存在，这使患者更容易发生 SSI、CRP 升高或需要抗生素治疗。CRP 水平是一个重要因素，其升高值可能是术后治疗许多负面方面的预测因素。
