Empey Rebecca, Ko Hyunkyu, Nirula Ram
Surgery, University of Utah Health, Salt Lake City, Utah, USA.
University of Utah, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Trauma Surg Acute Care Open. 2024 Dec 31;9(1):e001568. doi: 10.1136/tsaco-2024-001568. eCollection 2024.
Morning postoperative labs are often obtained for emergency general surgery (EGS) patients. Studies in other surgical fields indicate that routine postoperative day 1 (POD1) labs are sometimes being performed excessively and do not require intervention. The purpose of this study is to identify predictors indicating the need for POD1 labs in EGS patients based on likelihood of intervention.
This is a retrospective review of non-critically ill EGS patients from 2022 to 2023 who received POD1 morning labs. The odds of having an abnormal result and likelihood of intervention were measured through multivariate logistic regression accounting for patient characteristics and procedure. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed to determine significant predictors of an abnormal result and intervention.
502 EGS patients were included. LASSO revealed that procedure duration, fever, lysis of adhesions, preoperative systolic blood pressure <90 mm Hg, older age, heart failure, operative blood loss, chronic kidney disease, and anticoagulation use were independent predictors for any abnormal result (area under the receiver operation curve (AUC)=0.785). Independent predictors of intervention were procedure duration, older age, higher estimated blood loss (EBL), anticoagulant use, and lysis of adhesions (AUC=0.704). Procedures >400 min carried an 84.3% chance of an abnormal lab requiring intervention. EBL >200 mL carried a 75.5% chance of an abnormal lab requiring intervention.
POD1 labs for non-critically ill EGS patient rarely require intervention and can be safely omitted. Labs should be considered for longer procedures, higher EBLs, older patients, those on anticoagulation, or after lysis of adhesions.
急诊普通外科（EGS）患者术后常进行晨起实验室检查。其他外科领域的研究表明，术后第1天（POD1）的常规实验室检查有时过度进行，且无需干预。本研究的目的是根据干预可能性确定EGS患者中提示需要进行POD1实验室检查的预测因素。
这是一项对2022年至2023年接受POD1晨起实验室检查的非危重症EGS患者的回顾性研究。通过多变量逻辑回归分析患者特征和手术情况，测量出现异常结果的几率和干预可能性。进行最小绝对收缩和选择算子（LASSO）回归分析以确定异常结果和干预的显著预测因素。
纳入502例EGS患者。LASSO分析显示，手术持续时间、发热、粘连松解、术前收缩压<90 mmHg、年龄较大、心力衰竭、术中失血、慢性肾病和抗凝药物使用是任何异常结果的独立预测因素（受试者操作特征曲线下面积（AUC）=0.785）。干预独立预测因素为手术持续时间、年龄较大、估计失血量（EBL）较高、抗凝药物使用和粘连松解（AUC=0.704）。手术时间 >400分钟时，实验室检查异常且需要干预的几率为84.3%。EBL >200 mL时，实验室检查异常且需要干预的几率为75.5%。
非危重症EGS患者的POD1实验室检查很少需要干预，可以安全省略。对于手术时间较长、EBL较高、年龄较大、使用抗凝药物的患者或粘连松解术后患者，应考虑进行实验室检查。
