Surgery in practice and science最新文献_第8页

The association of closed-collaborative SICU modeling on emergency general surgery patient outcomes 封闭协作SICU模型与急诊普外科患者预后的关系

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100194

Joshua W. Bennett , Kiley R. Schlortt , Tianyuan Yao , Hanna K. Jensen , Rebecca J. Reif , Judy L. Bennett , Saleema A. Karim , Mary K. Kimbrough , Avi Bhavaraju

Objective

Surgical intensive care unit (SICU) optimization is a critical factor impacting patient outcomes and resource utilization. SICUs operate using an open or closed model, where the surgeon or intensivist, respectively, manages critically-ill patients. In 2017, we adopted a closed-collaborative model. This study aimed to compare patient outcomes in the closed-collaborative model vs. the previous open model in a cohort of emergency general surgery (EGS) patients.

Methods

A retrospective review of EGS SICU patients from August 2015 to July 2019 was performed. Patients were divided into "Open" and "Closed" cohorts before or after closed-collaborative model implementation on August 1, 2017. Demographic variables and clinical outcomes were analyzed.

Results

We identified 434 patients (O:191; C:243). While no significant demographic differences were observed, there was a higher proportion of patients with qSOFA scores greater than 2 in the closed cohort. There were no differences regarding sepsis, cerebrovascular accident, myocardial infarction, venous thromboembolism, anemia, SICU length of stay (LOS), SICU costs, ventilation requirements, or ventilator duration; mortality rate was higher, but hospital LOS was shorter in the closed cohort.

Conclusion

Overall, outcomes were not statistically different between the two models, despite sicker patients in the closed group, which we suspect accounts for the higher mortality in this group. We expect the decreased hospital LOS observed in the closed cohort improved bed management, patient flow, and ultimately led to institutional cost savings. Further investigation is warranted to examine SICU modeling effects in other surgical specialties and to evaluate potential hospital-level administrative benefits.

目的外科重症监护病房(SICU)优化是影响患者预后和资源利用的关键因素。sicu采用开放式或封闭式模式，由外科医生或重症监护医生分别管理危重病人。2017年，我们采取封闭协作模式。本研究旨在比较急诊普外科(EGS)患者队列中封闭协作模式与先前开放模式的患者预后。方法对2015年8月至2019年7月EGS SICU患者进行回顾性分析。在2017年8月1日实施封闭协作模式前后，将患者分为“开放”和“封闭”两组。分析人口学变量和临床结果。结果共发现434例患者(0:191;C: 243)。虽然没有观察到显著的人口统计学差异，但在封闭队列中，qSOFA评分大于2分的患者比例较高。脓毒症、脑血管意外、心肌梗死、静脉血栓栓塞、贫血、SICU住院时间(LOS)、SICU费用、通气要求或呼吸机持续时间方面无差异;在封闭队列中，死亡率较高，但医院LOS较短。总的来说，两种模式之间的结果没有统计学差异，尽管封闭组的患者病情较重，我们怀疑这是该组死亡率较高的原因。我们期望在封闭队列中观察到的降低的医院LOS改善了床位管理，患者流量，并最终导致机构成本节约。有必要进一步研究SICU模型在其他外科专科的效果，并评估潜在的医院级管理效益。

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引用次数: 0

The sandwich technique to treat aortoiliac aneurysms: How to size the parallel graft 夹层技术治疗髂主动脉动脉瘤:如何确定平行移植物的大小

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100208

Bilal Koussayer , Louai Zaidan , Anas Atassi , Bassam Khalil , Samer Koussayer

Introduction

The current gold standard of treatment aortoiliac aneurysms are through endovascular aneurysm repairs which can result in occluding the internal iliac artery. An alternative that preserves internal iliac artery blood flow is the sandwich technique. This is when two covered stents of the internal and external iliac arteries are placed inside the main limb of common iliac artery stent. The complexity of such task is complicated by efficiently calculating the size of the stent grafts to ensure a proper fit.

Methods

We have developed a mathematical proof that depends on the arterial circumferences to size the three stents needed for the sandwich technique: $D ≅ [0.68 * (d_{1} + d_{2})] + 2$ . D is the diameter of the common iliac stent, d₁ and d₂ is the diameter of the internal and external iliac artery stent. We added 2 mm to account for the thickness of stents.

Results

We have treated 10 common iliac artery aneurysms using this formula. Patients were followed up by CTA scans three, six and twelve months after the procedure. Seven of ten had complete sealing and no type III endoleaks intraoperatively. The other three had a small, limited type III endoleak at completion angiogram, that disappeared completely on the three months follow-up. At one-year follow up only one patient developed moderate claudication and erectile dysfunction.

Conclusion

ST is considered a practical and feasible approach, as it is easy to implement and can be utilized in most cases, especially in emergencies. It is also cost effective due the use of standard grafts without the need for specialized stents. Our aiming by improving this surgical technique is that we will be able to help standardize practice leading to reduced waste, maintain longer-term repair and therefore reduce complication risks.

目前治疗髂主动脉动脉瘤的金标准是通过血管内动脉瘤修复，这可能导致髂内动脉闭塞。另一种保留髂内动脉血流的方法是三明治技术。这是将两个覆盖的髂内、外动脉支架置入髂总动脉支架的主肢内。通过有效地计算支架的大小以确保合适的配合，使这项任务的复杂性变得复杂。我们已经开发了一种数学证明，它依赖于动脉周长来确定三明治技术所需的三个支架的大小:D = [0.68*(d1+d2)]+2。D为髂总支架直径，d1、d2为髂内外动脉支架直径。考虑到支架的厚度，我们增加了2mm。结果应用该方法治疗10例常见髂动脉瘤。患者在手术后3个月、6个月和12个月接受了CTA扫描。其中7例术中完全密封，无III型内漏。其他3例患者在血管造影中有一个小的，有限的III型内漏，在3个月的随访中完全消失。在一年的随访中，只有一名患者出现中度跛行和勃起功能障碍。结论st是一种实用可行的方法，易于实施，在大多数情况下都可以使用，特别是在紧急情况下。由于使用标准移植物而不需要专门的支架，它也具有成本效益。我们通过改进这种手术技术的目标是，我们将能够帮助规范实践，减少浪费，维持长期修复，从而降低并发症的风险。

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引用次数: 0

The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study 南非农村或城市环境与老年创伤患者预后之间的相关性：一项回顾性队列研究

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100184

Bogo Lee , Victor Kong , Cynthia Cheung , Nigel Rajaretnam , John Bruce , Vasel Manchev , Robert Mills , Damian Clarke

Introduction

This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa.

Materials and Methods

This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2013 to December 2020 to our trauma centre at Grey's Hospital, South Africa.

Results

Over the 8-year study period, a total of 323 patients aged ≥ 65 years were included (201 males (62%), mean age: 72 years. Mechanism of injury: 257 blunt (80%), 52 penetrating (16%) and 14 others (4%). The median Injury Severity Score (ISS) was 9. The median Charlson Comorbidity Index (CCI) for all 323 cases was 3. The median length of hospital stay was two days. The overall mortality was 12%. The crude odds ratio (OR) for death in rural vs urban patients was 2.51 (95% CI 1.27 – 4.94). After propensity score stratification for ISS, heart rate (HR), respiratory rate (RR), Glasgow Coma Scale (GCS) and temperature, and adjustment for mechanism, operation, Intensive Care Unit (ICU) and need for mechanical ventilation, the risk of death among the rural patients remained higher than in urban patients at 2.46 times (p=0.063), however, it was not statistically significant. Those who were operated on were significantly less likely to die after adjustment for confounding factors. Admission to ICU and the need for mechanical ventilation were significantly associated with mortality.

Conclusion

Rural geriatric trauma patients have worse outcomes than urban geriatric trauma even after adjustment for differences in demographic and injury profile.

本研究比较了南非一家主要创伤中心农村和城市老年创伤患者的预后。材料和方法本回顾性队列研究来自前瞻性输入的数据集，回顾了2013年1月至2020年12月在南非格雷医院创伤中心收治的所有65岁及以上患者。结果在8年的研究期间，共纳入年龄≥65岁的患者323例，其中男性201例(62%)，平均年龄72岁。伤机制:钝器257例(80%)，穿透52例(16%)，其他14例(4%)。损伤严重程度评分(ISS)中位数为9。323例患者的Charlson共病指数(CCI)中位数为3。住院时间中位数为2天。总死亡率为12%。农村与城市患者死亡的粗优势比(OR)为2.51 (95% CI 1.27 - 4.94)。经ISS、心率(HR)、呼吸频率(RR)、格拉斯哥昏迷量表(GCS)、体温、机制、操作、重症监护病房(ICU)、机械通气需求调整等倾倾向评分分层后，农村患者的死亡风险仍高于城市患者，为2.46倍(p=0.063)，但差异无统计学意义。在调整混杂因素后，接受手术的患者死亡的可能性明显降低。ICU住院和机械通气需求与死亡率显著相关。结论农村老年创伤患者的预后比城市老年创伤患者差，即使在调整了人口统计学和损伤特征的差异后也是如此。

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引用次数: 0

Reduced rates of pneumonia after implementation of an electronic checklist for the management of patients with multiple rib fractures at a Level One Trauma Center 在一级创伤中心实施电子检查表管理多发性肋骨骨折患者后肺炎发病率降低

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100192

Kevin Yeh , Nicole Spence , Brendin R Beaulieu-Jones , Michael Taylor , Ansel Jhaveri , Kathleen Centola , Tricia Charise , Janet Orf , Aaron Richman

Background

Traumatic rib fractures are associated with increased morbidity and mortality, with complications including pneumothorax, difficult to control pain, and pneumonia. Use of a bundled, multi-disciplinary approach to the care of patients with multiple rib fractures has been shown to reduce morbidity and mortality. In this study, we investigate the implementation of a checklist for the multidisciplinary management of patients with multiple rib fractures who present to an urban, level 1 trauma center and safety-net hospital.

Study design

This was a single-institution, retrospective cohort study to assess changes in treatment characteristics and patient outcomes before and after implementation of a comprehensive checklist for the management of high-risk patients with three or more traumatic rib fractures at a level-one trauma center. The primary outcome was pneumonia rates with secondary outcomes of mechanical ventilation rates and mechanical ventilation days, ICU length of stay, mortality, and non-opioid and opioid consumption (morphine milligram equivalents).

Results

A total of 104 patients met study eligibility, including 51 patients who presented during the pre-protocol period and 53 patients who received care after implementation. We observed that the checklist was utilized and reviewed in 83% of patients during the post-protocol period. Pneumonia rates were significantly lower in the post-protocol group (35.3% vs 15.1%, p = 0.017). There was no difference in the number of patients who required mechanical ventilation or the duration of mechanical ventilation. On unadjusted analysis, median overall length of stay (11.5 days vs 13 days, p = 0.71), median ICU stay (4 days vs 5 days, p = 0.18), and rate of in-hospital mortality (11.8% vs 7.6%, p = 0.47) was not different between the two time periods.

Conclusion

In patients with chest wall trauma and associated rib fractures, implementation of a standardized, multidisciplinary checklist to ensure utilization of multimodal analgesia and non-pharmacological interventions was associated with decreased pneumonia rates at our institution.

背景:外伤性肋骨骨折与发病率和死亡率增加有关，并伴有气胸、难以控制的疼痛和肺炎等并发症。使用捆绑的、多学科的方法来护理多处肋骨骨折的患者已被证明可以降低发病率和死亡率。在这项研究中，我们调查了在城市一级创伤中心和安全网医院就诊的多发性肋骨骨折患者的多学科管理清单的实施情况。研究设计:这是一项单机构、回顾性队列研究，旨在评估在一级创伤中心对三例或三例以上外伤性肋骨骨折的高危患者实施综合检查表前后治疗特点和患者结局的变化。主要结局是肺炎发生率，次要结局是机械通气率和机械通气天数、ICU住院时间、死亡率、非阿片类药物和阿片类药物消耗(吗啡毫克当量)。结果104例患者符合研究条件，其中51例患者在方案前就诊，53例患者在实施后接受治疗。我们观察到，83%的患者在方案后期间使用和回顾了检查表。方案后组肺炎发生率显著降低(35.3% vs 15.1%， p = 0.017)。在需要机械通气的患者数量或机械通气持续时间方面没有差异。在未经调整的分析中，两个时间段的总住院时间中位数(11.5天vs 13天，p = 0.71)、ICU住院时间中位数(4天vs 5天，p = 0.18)和住院死亡率中位数(11.8% vs 7.6%， p = 0.47)没有差异。结论:在胸壁创伤和相关肋骨骨折患者中，实施标准化的多学科检查表以确保多模式镇痛和非药物干预的使用与降低我院肺炎发病率相关。

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引用次数: 0

Preoperative levels of physical activity can be increased in pancreatectomy patients via a remotely monitored, telephone-based intervention: A randomized trial 一项随机试验:通过远程监测、基于电话的干预，可以增加胰腺切除术患者的术前体力活动水平

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-08-29 DOI: 10.1016/j.sipas.2023.100212

Jorge G. Zarate Rodriguez , Heidy Cos , Rohit Srivastava , Alice Bewley , Lacey Raper , Dingwen Li , Ruixuan Dai , Gregory A. Williams , Ryan C. Fields , William G. Hawkins , Chenyang Lu , Dominic E. Sanford , Chet W. Hammill

Background

Higher levels of preoperative physical activity are associated with improved outcomes after pancreatectomy, but it remains unclear if preoperative activity levels are modifiable.

Methods

Patients undergoing pancreatectomy were randomized 1:1 to a telephone-based intervention at least one week before surgery or to control. All patients wore wearable devices to remotely collect physical activity and clinical data.

Results

In total, 152 patients were enrolled and 83 completed the study (41 intervention and 42 control). The intervention group walked 4568 (SD 2522) average daily steps pre-intervention, which increased to 5071 (SD 3055) post-intervention (p = 0.042) (11.0% increase). The control group walked 5260 (SD 2795) average daily steps. There were no differences in the rate of severe complications between groups (intervention 22.9% vs control 20.5%, p = 0.807).

Conclusions

A telephone-based intervention increased average daily step count in patients scheduled to undergo pancreatectomy, demonstrating physical activity is a modifiable target for surgical prehabilitation protocols.

背景:术前较高水平的体力活动与胰腺切除术后预后的改善有关，但尚不清楚术前体力活动水平是否可以改变。方法胰切除术患者按1:1随机分组，在手术前至少一周接受电话干预或对照组。所有患者都佩戴可穿戴设备，远程收集身体活动和临床数据。结果共入组152例，完成研究83例(干预41例，对照组42例)。干预组干预前平均每日步行4568步(SD 2522)，干预后平均每日步行5071步(SD 3055) (p = 0.042)，增幅为11.0%。对照组平均每天步行5260步(SD 2795)。两组间严重并发症发生率无差异(干预组22.9% vs对照组20.5%，p = 0.807)。结论电话干预增加了计划行胰腺切除术患者的平均每日步数，表明身体活动是手术前康复方案的可修改目标。

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引用次数: 0

Residential Distance to the Cancer Center and Outcomes after Robotic-Assisted Pulmonary Lobectomy 机器人辅助肺叶切除术后到癌症中心的居住距离和预后

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-08-25 DOI: 10.1016/j.sipas.2023.100210

Allison O. Dumitriu Carcoana , Jenna C. Marek , William J. West III , Cole R. Fiedler , William N. Doyle Jr. , Kristie M. Labib , Lauren C. Ladehoff , Jose A. Malavet , Gregory Fishberger , Carla C. Moodie , Joseph R. Garrett , Jenna R. Tew , Jobelle J.A.R. Baldonado , Jacques P. Fontaine , Eric M. Toloza

Background

Outcomes of lung cancer patients traveling greater distances for surgical oncology care are not well-described. We investigated the effects of increased travel burden after robotic-assisted pulmonary lobectomy (RAPL) for lung cancer.

Methods

Clinical characteristics and surgical outcomes of 711 consecutive patients who underwent RAPL from September 2010 to March 2022 were compared, stratified by primary residential ZIP code <160 km or ≥160 km from the cancer center.

Results

Of 711 study patients, 515 (72.4%) lived within 160 km and 196 (27.6%) lived ≥160 km away. There were no differences in Charlson Comorbidity Index scores or tumor characteristics. Those traveling ≥160 km experienced more unfavorable perioperative outcomes and postoperative complications, and had worse median survival time by 1.68 years, but this survival difference did not reach statistical significance.

Conclusions

With the growing centralization of cancer care, travel burden may emerge as a predictor of surgical oncology outcomes.

背景:肺癌患者长途跋涉接受外科肿瘤治疗的结果尚未得到很好的描述。我们研究了机器人辅助肺叶切除术(RAPL)治疗肺癌后旅行负担增加的影响。方法比较2010年9月至2022年3月连续711例接受RAPL的患者的临床特征和手术结果，按主要居住邮政编码距离癌症中心160公里或≥160公里进行分层。结果711例患者中，515例(72.4%)居住在160公里以内，196例(27.6%)居住在≥160公里。两组在Charlson合并症指数评分和肿瘤特征方面均无差异。行程≥160 km的患者围手术期预后及术后并发症较多，中位生存时间差1.68年，但差异无统计学意义。结论随着肿瘤治疗的日益集中，旅行负担可能成为肿瘤手术预后的预测指标。

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引用次数: 0

Evaluating the feasibility of a normalized competitive index (NCI) to assess the competitiveness of general surgery residency 评估标准化竞争指数(NCI)评估普外科住院医师竞争力的可行性

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-08-18 DOI: 10.1016/j.sipas.2023.100207

Rebecca N. Treffalls , John A. Treffalls , Ali M. Michelotti , Qi Yan , Mark G. Davies

Background

General surgery remains the predominant surgical training pathway; however, the trends in competitiveness over time are unknown. The aim of this study was to determine the feasibility of using a normalized competitive index (NCI) to assess competitiveness by analyzing 30 years of general surgery match data.

Methods

Data for general surgery programs were collected using the National Resident Matching Program (NRMP) Main Residency Match data from 1993 to 2022. Matched applicant metrics from 2007 to 2021 were collected via NRMP Charting Outcomes data. Metrics included USMLE Step 1 and 2 scores, research experiences and output, work experiences, and volunteer experiences. A competitive index was created by dividing number of positions by the match rate each year. The index was normalized, creating the NCI for trends over time. Linear regressions were performed on the NCI, match data, and applicant metrics across time.

Results

The NCI significantly differed across time (p = 0.02) with an upward-trending NCI slope; however, there were substantial fluctuations over time. The overall match rate increased over time (p<0.001), and applicants per position decreased over time (p<0.001). The USMLE Step 1 and Step 2 scores of matched applicants increased over time (R²=0.92 and R²=0.95, p < 0.001). Research output has tripled over the 2007–2021 period (2.2 vs. 7, p < 0.001). Step 2 and research output correlated with NCI (Pearson r = 0.89 and r = 0.97) but did not correlate with the match rate.

Conclusion

The competitiveness of general surgery residency programs was highly variable over time. Over the last ten years, there has been a significant increase in applicants per position and applicant metrics. The fluctuations in standard metrics of competitiveness (i.e., applicants per position, USMLE scores, research output) correlated with fluctuations in the NCI, while the match rate was relatively stable over time. This study demonstrates that the NCI may be a valuable metric for applicants to determine or predict the competitiveness of a residency program.

背景普外科仍然是主要的外科培训途径;然而，随着时间的推移，竞争力的趋势是未知的。本研究的目的是通过分析30年的普外科手术匹配数据，确定使用标准化竞争指数(NCI)来评估竞争力的可行性。方法采用1993 - 2022年全国住院医师匹配计划(NRMP)主要住院医师匹配数据收集普外科项目数据。通过NRMP图表结果数据收集了2007年至2021年匹配的申请人指标。指标包括USMLE第1步和第2步得分、研究经历和产出、工作经历和志愿者经历。竞争指数是用每年的职位数除以匹配率得出的。该指数被归一化，形成了NCI随时间变化的趋势。对NCI、匹配数据和申请人指标进行线性回归。结果NCI随时间差异显著(p = 0.02)， NCI斜率呈上升趋势;然而，随着时间的推移，有很大的波动。总体匹配率随着时间的推移而增加(p<0.001)，每个职位的申请人数随着时间的推移而减少(p<0.001)。匹配申请人的USMLE步骤1和步骤2分数随时间的推移而增加(R2=0.92和R2=0.95, p <0.001)。2007年至2021年期间，研究产出增长了两倍(2.2 vs. 7, p <0.001)。步骤2和研究产出与NCI相关(Pearson r = 0.89和r = 0.97)，但与匹配率不相关。结论普外科住院医师项目的竞争力随时间变化很大。在过去的十年里，每个职位的申请人数量和申请人指标都有了显著的增长。竞争力的标准指标(即每个职位的申请人、USMLE分数、研究产出)的波动与NCI的波动相关，而匹配率随着时间的推移相对稳定。这项研究表明，NCI可能是申请人确定或预测住院医师计划竞争力的一个有价值的指标。

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引用次数: 0

Reducing healthcare delivery costs using Augmented Reality based Surgical Simulation: A Health Economics Study 使用基于手术模拟的增强现实降低医疗保健交付成本:一项卫生经济学研究

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-07-01 DOI: 10.1016/j.sipas.2023.100200

D. Rawaf, E. Street, J. Van Flute, L. Tenang

引用次数: 0

Developing a novel laparoscopic training model during the Covid-19 pandemic in a resource-limited setting 在资源有限的情况下，在Covid-19大流行期间开发一种新的腹腔镜培训模式

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-06-01 DOI: 10.1016/j.sipas.2023.100170

Dr Hansraj Mangray , Dr Sanele Madziba , Dr Shamaman Harilal , Dr Vishendran Govindasamy , Dr Morganyagi Govender , Dr Lucien Ferndale , Dr Thembi Mbebe , Dr Ashish Dasrath , Prof Damian L Clarke

Background

This paper describes the development and implementation of a unique laparoscopic suturing course in a resource-constrained setting and reviews the initial experience with the program.

Methods

This study describes the development of Grey's laparoscopic suturing course (GLSC) and reviews the questionnaires and feedback over the past year.

Results

The GLSC has been run for over a year and has enrolled 47 participants. Most participants were registrars, followed by consultants and medical officers, and most participants had limited minimal access surgery (MAS) experience. Only three had previously undertaken a formal course or observership. The mean result for the pre-course test was 50%, and for the post-course test, 88%. During the skills laboratory session, every participant competently performed intra-corporeal suturing. The entire group unanimously agreed that the GLSC should be recommended for all surgical trainees in the evaluation form. All participants expressed interest in an advanced MAS course.

Conclusion

We have demonstrated that developing a local MAS suturing course with limited resources and industry support during the Covid 19 pandemic is possible. It has benefited a large group of trainees thus far and hopefully will become part of the curriculum of surgical trainees in South Africa.

本文描述了在资源有限的情况下开发和实施一种独特的腹腔镜缝合课程，并回顾了该计划的初步经验。方法介绍格雷腹腔镜缝合课程(GLSC)的发展，回顾一年来的调查问卷和反馈。结果GLSC已运行一年多，共有47名参与者。大多数参与者是登记员，其次是顾问和医务人员，大多数参与者具有有限的最小接触手术经验。只有三个人以前参加过正式课程或担任过观察员。课程前测试的平均结果为50%，课程后测试的平均结果为88%。在技能实验室课程中，每个参与者都熟练地进行了身体内缝合。全组一致同意在评估表中推荐所有外科培训生使用GLSC。所有参与者都对高级MAS课程感兴趣。结论在有限的资源和行业支持下，在2019冠状病毒病大流行期间开发本地MAS缝合课程是可能的。到目前为止，它已使一大群受训人员受益，并有望成为南非外科受训人员课程的一部分。

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引用次数: 1

Short- and long-term outcomes in the nonoperative treatment of diverticular abscesses 分流器脓肿非手术治疗的短期和长期疗效

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-06-01 DOI: 10.1016/j.sipas.2023.100180

Arshad M. Bachelani , Laura A. Holton , Youssef Soliman

Introduction

Recommendations for surgery of diverticular abscesses continue to evolve. This study aimed to examine the short- and long-term results of nonoperative management of diverticular abscesses while analyzing granular data to assess for predictive factors for successful treatment.

Materials and methods

We analyzed patients admitted with diverticular abscesses at Penn Highlands Mon Valley Hospital from 2010 to 2020 who received initial planned nonoperative management. Short-term failure was defined as requiring surgery within 60 days of diagnosis, whereas long-term failure was defined as requiring surgery beyond 60 days. Successful treatment was defined as treatment that did not require surgery.

Results

In total, 857 patient charts were individually analyzed. Sixty-three patients met the inclusion criteria. The median follow-up period was 48 months. Nineteen (30.2%) patients experienced short-term failure of nonoperative management, whereas 6 (9.5%) patients experienced long-term failure. Surgery was successfully avoided in the remaining 41 (60.3%) patients. Abscess size was significantly associated with success rate (< 3 cm, 85.7%; 3–5 cm, 42.3%; > 5 cm, 33.3%; p = 0.001). When corrected for the abscess size, percutaneous drainage did not affect the requirement for eventual surgery.

Conclusions

Nonoperative management is a reasonable option for diverticular abscesses and is particularly successful in patients with abscesses < 3 cm in diameter. Although sometimes performed in conjunction with nonoperative management, percutaneous drainage does not decrease the requirement for eventual surgery. Elective surgery should be considered for patients with larger abscesses. Future prospective studies may further clarify the role of the nonoperative management of diverticular abscesses.

憩室脓肿手术的建议仍在不断发展。本研究旨在研究憩室脓肿非手术治疗的短期和长期结果，同时分析颗粒数据以评估成功治疗的预测因素。材料和方法我们分析了2010年至2020年在宾州高地蒙谷医院接受初步计划非手术治疗的憩室脓肿患者。短期失败定义为诊断60天内需要手术，而长期失败定义为60天以上需要手术。成功的治疗被定义为不需要手术的治疗。结果共分析857例患者病历。63例患者符合纳入标准。中位随访期为48个月。非手术治疗短期失败19例(30.2%)，长期失败6例(9.5%)。其余41例(60.3%)患者成功避免手术。脓肿大小与手术成功率显著相关(<3厘米，85.7%;3-5 cm，占42.3%;比;5厘米，33.3%;p = 0.001)。当对脓肿大小进行校正后，经皮引流不影响最终手术的要求。结论非手术治疗是憩室脓肿的合理选择，对憩室脓肿患者尤其有效;直径3厘米。虽然有时与非手术治疗相结合，经皮引流并不减少最终手术的需要。对于脓肿较大的患者应考虑择期手术。未来的前瞻性研究可能会进一步阐明憩室脓肿非手术治疗的作用。

{"title":"Short- and long-term outcomes in the nonoperative treatment of diverticular abscesses","authors":"Arshad M. Bachelani , Laura A. Holton , Youssef Soliman","doi":"10.1016/j.sipas.2023.100180","DOIUrl":"10.1016/j.sipas.2023.100180","url":null,"abstract":"<div><h3>Introduction</h3><p>Recommendations for surgery of diverticular abscesses continue to evolve. This study aimed to examine the short- and long-term results of nonoperative management of diverticular abscesses while analyzing granular data to assess for predictive factors for successful treatment.</p></div><div><h3>Materials and methods</h3><p>We analyzed patients admitted with diverticular abscesses at Penn Highlands Mon Valley Hospital from 2010 to 2020 who received initial planned nonoperative management. Short-term failure was defined as requiring surgery within 60 days of diagnosis, whereas long-term failure was defined as requiring surgery beyond 60 days. Successful treatment was defined as treatment that did not require surgery.</p></div><div><h3>Results</h3><p>In total, 857 patient charts were individually analyzed. Sixty-three patients met the inclusion criteria. The median follow-up period was 48 months. Nineteen (30.2%) patients experienced short-term failure of nonoperative management, whereas 6 (9.5%) patients experienced long-term failure. Surgery was successfully avoided in the remaining 41 (60.3%) patients. Abscess size was significantly associated with success rate (< 3 cm, 85.7%; 3–5 cm, 42.3%; > 5 cm, 33.3%; <em>p</em> = 0.001). When corrected for the abscess size, percutaneous drainage did not affect the requirement for eventual surgery.</p></div><div><h3>Conclusions</h3><p>Nonoperative management is a reasonable option for diverticular abscesses and is particularly successful in patients with abscesses < 3 cm in diameter. Although sometimes performed in conjunction with nonoperative management, percutaneous drainage does not decrease the requirement for eventual surgery. Elective surgery should be considered for patients with larger abscesses. Future prospective studies may further clarify the role of the nonoperative management of diverticular abscesses.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"13 ","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47468241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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