Delay in emergency hernia surgery is associated with worse outcomes.
Delay in emergency hernia surgery is associated with worse outcomes.
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DOI：
10.1007/s00464-019-07245-4
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Kent AJ
中科院分区：
文献类型：
--
作者：
Leeds IL;Jones C;DiBrito SR;Sakran JV;Haut ER;Kent AJ
需要紧急手术治疗疝的患者在表现和治疗方面差异很大。本研究的目的是确定紧急手术时间的变化是否会影响手术结果。通过初步术后诊断，查询了2011-2016年国家NSQIP数据库中因腹壁疝导致梗阻或坏疽的紧急手术。排除膈疝。根据从入院到手术当天的手术时间对患者进行分组：当天、第二天和更长时间的延迟。使用多项倾向评分加权来解决时间组之间基础协变量聚类的潜在差异，然后对发病率和死亡率进行多变量logistic回归。加权分析得出的有效样本量为76，364。疝类型包括腹股沟疝（20.9%）、股疝（6.7%）、脐疝（20.2%）、腹疝（41.0%）和其他疝（10.4%）。延迟手术与主要并发症的发生率增加有关（26.4% vs 20.9%，p<0.001），手术时间较长（+12.5分钟，p<0.001），术后住院时间更长（+1.6天，p<0.001），再次手术增加（5.9% vs 4.7%，p=0.019），再入院率增加（7.0% vs 5.7%，p=0.004），30天死亡率增加（2.4% vs 1.7%，p=0.002）。当控制其他因素时，次日手术（OR = 1.23，95% CI：1.05-1.45，p=0.009）和手术延迟超过1天（OR = 1.40，95% CI：1.13-1.73，p<0.002）与重大并发症的几率增加相关。死亡率和再入院率与手术时间无关。急诊疝手术延迟增加了主要发病率的几率，但不增加死亡率。患有疝并有紧急手术干预指征的患者可以从尽快可行的手术中受益，而不是等待进一步的生理优化，医疗许可或专业手术人员。
Patients requiring emergent surgery for hernia vary widely in presentation and management. The purpose of this study was to determine if the variation in timing of urgent surgery impacts surgical outcomes. The national NSQIP database for years 2011-2016 was queried for emergent surgeries for abdominal hernia resulting in obstruction or gangrene by primary post-op diagnosis. Diaphragmatic hernias were excluded. Patients were grouped by surgical timing from admission to day of surgery: same day, next day, and longer delay. Multinomial propensity score weighting was used to address potential differences in underlying covariates’ clustering across the timing groups followed by multivariable logistic regression of morbidity and mortality. Weighted analysis yielded an effective sample size of 76,364. Hernia types included inguinal (20.9%); femoral (6.7%); umbilical (20.2%); ventral (41.0%); and other (10.4%). Delayed surgery was associated with increased rates of major complications (26.4% versus 20.9%, p<0.001), longer operative times (+12.5 minutes, p<0.001), longer postoperative lengths of stay (+1.6 days, p<0.001), increased re-operations (5.9% versus 4.7%, p=0.019), increased readmissions (7.0% versus 5.7%, p=0.004), and increased 30-day mortality (2.4% versus 1.7%, p=0.002). When controlling for other factors, next-day surgery (OR = 1.23, 95% CI: 1.05-1.45, p=0.009) and surgery delayed more than one day (OR = 1.40, 95% CI: 1.13-1.73, p<0.002) were associated with an increased odds of a major complication. Mortality and readmission by timing of surgery were not independently significant. Delay in surgery for emergent hernias increased the odds of major morbidity but not mortality. Patients presenting with hernia and an indication for urgent surgical intervention may benefit from an operation as soon as feasible rather than warrant waiting for further physiologic optimization, medical clearance, or specialized surgical personnel.
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