Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-10-03 DOI:10.1007/s10151-024-03008-z

P H McClelland, T Liu, R P Johnson, C Glenn, G Ozuner

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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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结直肠手术中的先天性泌尿系统损伤：全国性队列的结果和风险因素。

背景：先天性泌尿系统损伤（IUI）可导致结直肠手术后的严重并发症，尤其是在诊断延迟的情况下。本研究分析了接受结直肠手术的患者中与先天性泌尿系统损伤和延迟先天性泌尿系统损伤相关的风险因素：方法：从美国外科学院国家外科质量改进计划（NSQIP®）数据库中筛选出 2012 年至 2021 年间接受结直肠手术的成人。采用多变量回归分析确定与人工授精和延迟人工授精相关的风险因素和结果：在566,036名患者中，5836名患者（1.0%）在结直肠手术后进行了人工授精，其中236名患者（4.0%）延迟了人工授精。发现了导致人工授精和延迟人工授精的多种术前风险因素，其中包括播散性癌症[调整后几率比（aOR）1.4，95% 置信区间（CI）1.2-1.5；P 结论：虽然IUI在结直肠手术中并不常见，但未被发现的损伤会使修复手术复杂化，并导致其他不良的术后结果。腹腔内病变复杂的患者发生 IUI 的风险更高，体型较大的患者接受腹腔镜手术时发生延迟 IUI 的风险更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.