Preoperative use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diuretics increases the risk of dehydration after ileostomy formation: population-based cohort study.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae051
Louise de la Motte, Caroline Nordenvall, Anna Martling, Christian Buchli
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Abstract

Background: Readmission rates following ileostomy formation are high. Dehydration and consecutive renal failure are common causes of readmission, potentially pronounced by drugs affecting the homeostasis. The aim of the study was to assess the risk of dehydration after ileostomy formation in patients treated with angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) or diuretics.

Method: This nationwide population-based cohort study used data derived from the Colorectal Cancer Data Base of several Swedish healthcare registers. The study included all patients operated on with elective anterior resection and temporary ileostomy for rectal cancer clinically staged I-III in Sweden in 2007-2016. Exposure was at least two dispensations of ACEI, ARB or diuretics within 1 year prior to surgery. Outcome was 90-day readmission due to dehydration including acute renal failure.

Results: In total, 3252 patients were included with 1173 (36.1%) exposed to ACEI, ARB or diuretics. The cumulative incidence for 90-day readmission due to dehydration was 29.0% (151 of 520) for exposed versus 13.8% (98 of 712) for unexposed. The proportion of readmissions due to any reason was 44.3% (520 of 1173) for exposed compared to 34.2% (712 of 2079) for unexposed. The incidence rate ratio for readmission due to dehydration was 2.83 (95% c.i. 2.21 to 3.63, P < 0.001). The hazard rate ratio was 2.45 (95% c.i. 1.83 to 3.27, P < 0.001) after adjusting for age, gender and comorbidity.

Conclusion: Medication with ACEI, ARB or diuretics defines a vulnerable patient group with increased risk of readmission due to dehydration after ileostomy formation.

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术前使用血管紧张素转换酶抑制剂、血管紧张素 II 受体阻滞剂和利尿剂会增加回肠造口术后脱水的风险:基于人群的队列研究。
背景:回肠造口术后的再入院率很高。脱水和连续性肾功能衰竭是再入院的常见原因,影响体内平衡的药物可能会导致脱水和连续性肾功能衰竭。本研究旨在评估使用血管紧张素转换酶抑制剂(ACEI)、血管紧张素 II 受体阻滞剂(ARB)或利尿剂治疗的患者在实施回肠造口术后脱水的风险:这项全国性人群队列研究使用的数据来自瑞典多家医疗保健登记机构的结直肠癌数据库。研究对象包括2007-2016年瑞典所有临床分期为I-III期的直肠癌择期前切除术和临时回肠造口术患者。患者在手术前一年内至少服用过两次 ACEI、ARB 或利尿剂。结果为因脱水(包括急性肾功能衰竭)导致的90天再入院:共纳入 3252 名患者,其中 1173 人(36.1%)使用过 ACEI、ARB 或利尿剂。因脱水导致的 90 天再入院累计发生率为:暴露患者 29.0%(520 例中的 151 例),未暴露患者 13.8%(712 例中的 98 例)。因任何原因再入院的比例,暴露者为 44.3%(1173 例中的 520 例),未暴露者为 34.2%(2079 例中的 712 例)。脱水导致再入院的发病率比为 2.83(95% 置信区间为 2.21 至 3.63,P < 0.001)。调整年龄、性别和合并症后,危险率比为2.45(95% c.i.1.83至3.27,P < 0.001):结论:使用 ACEI、ARB 或利尿剂可确定一个易受伤害的患者群体,其因回肠造口术后脱水而再次入院的风险会增加。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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