微创手术对接受急诊结肠切除术的体弱患者术后30天结局的影响。

The effect of minimally invasive surgery on thirty-day postoperative outcomes of frail patients undergoing emergency colon resections.

作者信息

Khan Muhammad Sohaib, Meier Jennie, Afsari Macy, Murimwa Gilbert Z, Pogacnik Javier S, Zeh Hebert J, Polanco Patricio M

机构信息

Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: https://twitter.com/KMuhammadSohaib.

Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: https://twitter.com/Jenniemeier.

出版信息

Surgery. 2025 Apr;180:109004. doi: 10.1016/j.surg.2024.109004. Epub 2024 Dec 20.

DOI:10.1016/j.surg.2024.109004

PMID:39708412

Abstract

BACKGROUND

Frail patients have poor outcomes after emergent colon surgery. While minimally invasive surgery has shown improved outcomes in the general patient population undergoing colectomy, the benefits in frail patients are unknown.

METHODS

We identified frail patients who underwent urgent or emergent colon resections from 2017 to 2021 in the National Surgical Quality Improvement Program database. We defined frail as a score of 2 or greater on the modified frailty index. We used inverse probability of treatment weighted analysis to determine the association of surgical technique with 30-day postoperative outcomes independent of confounding variables.

RESULTS

Of the 11,976 frail patients, 10,293 (87.2%) underwent open surgery and 1,503 (12.7%) underwent minimally invasive surgery. Patients who underwent open surgery had significantly more comorbid conditions. The most common diagnosis for patients who underwent open surgery was intra-abdominal sepsis (59.6%) and neoplasms for patients who underwent minimally invasive surgery (42%). After the inverse probability of treatment weighted analysis, the standardized difference was reduced to 1.7% or less. At 30 days from surgery, minimally invasive surgery was independently associated with reduced risk of death: 4.6% (odds ratio, 0.95; 95% confidence interval, 0.93-0.97; P < .001), severe complications: 6.9% (odds ratio, 0.93; 95% confidence interval, 0.90-0.95, P < .001), any complication: 8.8% (odds ratio, 0.91; 95% confidence interval, 0.88-0.94, P < .001), septic shock: 5.9% (odds ratio, 0.94; 95% confidence interval, 0.92-0.96 P < .001), postoperative bleeding: 4% (odds ratio, 0.95; 95% confidence interval, 0.93-0.98, P < .001), hospital stay >14 days: 4.2% (odds ratio, 0.95; 95% confidence interval, 0.92-0.99, P = .02).

CONCLUSION

In this vulnerable population of frail patients, minimally invasive surgery was associated with reduced risk of morbidity and mortality in the 30 days after emergency colectomy. A minimally invasive surgery approach should be considered in emergency colon surgeries, provided proficient resources are available.

摘要

背景

体弱患者急诊结肠手术后预后较差。虽然微创手术在接受结肠切除术的普通患者人群中已显示出更好的预后，但对体弱患者的益处尚不清楚。

方法

我们在国家外科质量改进计划数据库中确定了2017年至2021年接受紧急或急诊结肠切除术的体弱患者。我们将体弱定义为改良脆弱指数得分≥2分。我们使用治疗加权分析的逆概率来确定手术技术与30天术后结局之间的关联，不受混杂变量影响。

结果

在11976例体弱患者中，10293例（87.2%）接受了开放手术，1503例（12.7%）接受了微创手术。接受开放手术的患者合并症明显更多。接受开放手术患者最常见的诊断是腹腔内感染（59.6%），接受微创手术患者最常见的诊断是肿瘤（42%）。经过治疗加权分析的逆概率后，标准化差异降至1.7%或更低。术后30天时，微创手术与降低死亡风险独立相关：4.6%（比值比，0.95；95%置信区间，0.93 - 0.97；P <.001），严重并发症：6.9%（比值比，0.93；95%置信区间，0.90 - 0.95，P <.001），任何并发症：8.8%（比值比，0.91；95%置信区间，0.88 - 0.94，P <.001），感染性休克：5.9%（比值比，0.94；95%置信区间，0.92 - 0.96，P <.001），术后出血：4%（比值比，0.95；95%置信区间，0.93 - 0.98，P <.001），住院时间>14天：4.2%（比值比，0.95；95%置信区间，0.92 - 0.99，P =.02）。