ACS-NSQIP数据库对开放式和腹腔镜结肠切除术治疗缺血性结肠炎疗效的比较

IF 0.6 Q4 SURGERY Surgery in practice and science Pub Date : 2023-09-01 DOI:10.1016/j.sipas.2023.100188

Ben S. Duggan , Tim Becker , Genaro A. DeLeon , Varun Rao , Kevin Y. Pei

{"title":"ACS-NSQIP数据库对开放式和腹腔镜结肠切除术治疗缺血性结肠炎疗效的比较","authors":"Ben S. Duggan , Tim Becker , Genaro A. DeLeon , Varun Rao , Kevin Y. Pei","doi":"10.1016/j.sipas.2023.100188","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis.</p></div><div><h3>Methods</h3><p>Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression.</p></div><div><h3>Results</h3><p>7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, <em>p</em>=<0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, <em>p</em><0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, <em>p</em> = 0.2). Postoperative length of stay (7 vs 12 days, <em>p</em>=<0.001), septic shock (6.7% vs 27%, <em>p</em>=<0.001), and organ space SSI (3.2% vs 6.9%, <em>p</em>=<0.001) were significantly decreased using a laparoscopic approach.</p></div><div><h3>Discussion</h3><p>30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors.</p></div><div><h3>Conclusion</h3><p>Laparoscopic colectomy may be a better surgical approach for patients with ischemic colitis compared to open colectomy.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100188"},"PeriodicalIF":0.6000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A comparison of open or laparoscopic colectomy outcomes for the management of ischemic colitis using the ACS-NSQIP database\",\"authors\":\"Ben S. Duggan , Tim Becker , Genaro A. DeLeon , Varun Rao , Kevin Y. Pei\",\"doi\":\"10.1016/j.sipas.2023.100188\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis.</p></div><div><h3>Methods</h3><p>Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression.</p></div><div><h3>Results</h3><p>7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, <em>p</em>=<0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, <em>p</em><0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, <em>p</em> = 0.2). Postoperative length of stay (7 vs 12 days, <em>p</em>=<0.001), septic shock (6.7% vs 27%, <em>p</em>=<0.001), and organ space SSI (3.2% vs 6.9%, <em>p</em>=<0.001) were significantly decreased using a laparoscopic approach.</p></div><div><h3>Discussion</h3><p>30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors.</p></div><div><h3>Conclusion</h3><p>Laparoscopic colectomy may be a better surgical approach for patients with ischemic colitis compared to open colectomy.</p></div>\",\"PeriodicalId\":74890,\"journal\":{\"name\":\"Surgery in practice and science\",\"volume\":\"14 \",\"pages\":\"Article 100188\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2023-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgery in practice and science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666262023000347\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery in practice and science","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666262023000347","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

摘要

缺血性结肠炎是肠道缺血的一种常见表现，是一种潜在的外科急诊。虽然这种外科急诊历来都是通过开放探查来处理的，但目前还不确定微创技术是否有作用。本研究比较了开放式和腹腔镜结肠切除术治疗缺血性结肠炎的效果。方法利用美国外科医师学会(ACS)国家手术质量改进计划(NSQIP)数据库，对2005年至2019年接受结肠切除术的缺血性结肠炎患者进行比较。主要研究终点为30天死亡率。其他值得关注的结果包括手术相关的再入院、手术相关的再手术、住院时间、手术部位感染(SSI)、感染性休克和其他并发症。使用多元逻辑回归对相关结果进行比较。结果缺血性结肠炎7928例，其中开腹结肠切除术7209例，腹腔镜结肠切除术719例。与开放式手术相比，腹腔镜手术的死亡率显著降低(6.4% vs 26%， p=<0.001)，并且与较低的死亡率相关(OR 0.58;95% ci[0.35, 0.95])。腹腔镜组手术相关的再手术较低(6.5% vs 11%， p<0.001)，但多因素分析无统计学意义(OR 0.65;95% ci[0.43,1])。再入院率无统计学差异(12% vs 10%， p = 0.2)。腹腔镜入路术后住院时间(7天vs 12天，p=<0.001)、感染性休克(6.7% vs 27%， p=<0.001)和器官间隙SSI (3.2% vs 6.9%， p=<0.001)均显著降低。腹腔镜术后30天死亡率明显降低。接受腹腔镜结肠切除术的患者住院时间较短。虽然接受腹腔镜手术的患者往往较少生病，但多因素分析显示，在校正这些因素后，与开放式结肠切除术相比，败血症和手术部位感染的发生率降低。结论腹腔镜结肠切除术可能是治疗缺血性结肠炎较好的手术方式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

A comparison of open or laparoscopic colectomy outcomes for the management of ischemic colitis using the ACS-NSQIP database

Introduction

Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis.

Methods

Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression.

Results

7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, p=<0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, p<0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, p = 0.2). Postoperative length of stay (7 vs 12 days, p=<0.001), septic shock (6.7% vs 27%, p=<0.001), and organ space SSI (3.2% vs 6.9%, p=<0.001) were significantly decreased using a laparoscopic approach.

Discussion

30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors.