Shiraishi Takuya, Seki Takahiro, Katayama Chika, Shibasaki Yuta, Komine Chika, Osone Katsuya, Okada Takuhisa, Sano Akihiko, Sakai Makoto, Sohda Makoto, Shirabe Ken, Saeki Hiroshi
Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):375-382. doi: 10.23922/jarc.2024-046. eCollection 2024.
This study aimed to investigate preoperative factors, including the C-reactive protein (CRP)/albumin ratio (CAR), associated with postoperative outcomes in patients with colorectal perforation who underwent emergency surgery to improve postoperative prognosis.
Twenty-eight consecutive patients who underwent emergency surgery for colorectal perforations were included. We retrospectively investigated the clinical factors associated with their postoperative outcomes.
The median patient age was 69.5 years (range, 46.0-93.0 years); 13 patients (46.4%) were males and 15 (53.6%) were females. Colorectal cancer (8 [28.6%]) was the most common cause of colorectal perforation. Postoperative complications were diagnosed in 18 patients (64.3%), with intraabdominal abscess as the most common (6 [21.4%]). Multivariate analysis revealed that CAR (odds ratio, 1.357; 95% confidence interval, 1.056-1.743; p=0.017) was an independent risk factor for postoperative complications. A cutoff value of 4.9 was selected to predict the development of postoperative complications based on the CAR. The proportion of all postoperative complications (p=0.016), postoperative complications of Clavien-Dindo classification grade II or higher (p=0.002), and death during hospitalization (p=0.049) were significantly higher in the group of patients with CAR ≥ 4.9 than in those with CAR < 4.9. Additionally, intraabdominal abscess (p=0.049) was significantly higher in the group of patients with a non-improvement in CAR on postoperative day 3 than in those with an improvement in CAR on postoperative day 3.
Perioperative CAR could be a predictor of perioperative complications and death and might be useful in improving the postoperative prognosis of colorectal perforations.
本研究旨在调查术前因素，包括C反应蛋白（CRP）/白蛋白比值（CAR），与接受急诊手术的结直肠穿孔患者术后结局的相关性，以改善术后预后。
纳入28例连续接受结直肠穿孔急诊手术的患者。我们回顾性调查了与他们术后结局相关的临床因素。
患者中位年龄为69.5岁（范围46.0 - 93.0岁）；13例患者（46.4%）为男性，15例（53.6%）为女性。结直肠癌（8例[28.6%]）是结直肠穿孔最常见的原因。18例患者（64.3%）诊断有术后并发症，腹腔内脓肿最为常见（6例[21.4%]）。多因素分析显示，CAR（比值比，1.357；95%置信区间，1.056 - 1.743；p = 0.017）是术后并发症的独立危险因素。基于CAR选择4.9的临界值来预测术后并发症的发生。CAR≥4.9组的所有术后并发症比例（p = 0.016）、Clavien-Dindo分类II级或更高等级的术后并发症比例（p = 0.002）以及住院期间死亡率（p = 0.049）均显著高于CAR<4.9组。此外，术后第3天CAR无改善组的腹腔内脓肿发生率（p = 0.049）显著高于术后第3天CAR有改善组。
围手术期CAR可能是围手术期并发症和死亡的预测指标，可能有助于改善结直肠穿孔患者的术后预后。
