Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA.
Division of Colorectal Surgery, Baylor St. Luke's Medical Group, The Woodlands, TX, USA.
Tech Coloproctol. 2024 Oct 3;28(1):137. doi: 10.1007/s10151-024-03008-z.
Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures.
Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI.
Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI.
While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.
医源性尿路损伤（IUI）可导致结直肠手术后发生严重并发症，尤其是在诊断延迟的情况下。本研究分析了与结直肠手术后发生 IUI 和延迟性 IUI 相关的危险因素。
在美国外科医师学会国家手术质量改进计划（NSQIP）数据库中，确定了 2012 年至 2021 年期间接受结直肠手术的成年人。采用多变量回归分析确定与 IUI 和延迟性 IUI 相关的危险因素和结果。
在 566036 例患者中，5836 例（1.0%）在结直肠手术后发生 IUI，其中 236 例（4.0%）发生延迟性 IUI。确定了多个与 IUI 和延迟性 IUI 相关的术前危险因素，弥漫性癌症[校正优势比（aOR）1.4，95%置信区间（CI）1.2-1.5；p<0.001]和憩室病[aOR 1.1，95%CI 1.0-1.2；p=0.009]与 IUI 相关，而增加的体重指数[aOR 1.6，95%CI 1.2-2.1；p=0.003]和腹水[aOR 5.6，95%CI 2.1-15.4；p=0.001]与延迟性 IUI 相关。腹腔镜方法与 IUI 风险降低相关[aOR 0.4，95%CI 0.4-0.5；p<0.001]和延迟性 IUI 风险增加相关[aOR 1.8，95%CI 1.4-2.5；p<0.001]。IUI 和延迟性 IUI 均与显著的术后发病率相关，在延迟性 IUI 中可见严重的多器官并发症。
尽管 IUI 在结直肠手术中很少见，但未被识别的损伤会使修复复杂化并导致其他负面术后结果。有复杂腹腔内病理的患者发生 IUI 的风险增加，而体型较大的患者行腹腔镜手术发生延迟性 IUI 的风险增加。
