Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.
Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.
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DOI：
10.1001/archsurg.2012.12
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发表时间：
2012-04
影响因子：
--
通讯作者：
Flum, David R.
中科院分区：
文献类型：
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作者：
Kwon, Steve;Morris, Arden;Billingham, Richard;Frankhouse, Joseph;Horvath, Karen;Johnson, Morrie;McNevin, Shane;Simons, Anthony;Symons, Rebecca;Steele, Scott;Thirlby, Richard;Whiteford, Mark;Flum, David R.
为了评估常规吻合口泄漏检测（用于筛查泄漏）与选择性检测（用于评估高风险或技术上困难的吻合口的可疑泄漏）对结直肠手术结果的影响，因为结肠直肠吻合口的挑衅性检测作为质量改进指标的价值尚未确定。观察性前瞻性队列研究。数据来自华盛顿州外科护理和结果评估项目（SCOAP）。2005年10月1日至2009年12月31日，在SCOAP 40家医院接受选择性左侧结肠或直肠切除术的患者。使用泄漏检测，区分在特定日历季度中在选择性（<90%使用）或常规（≥90%使用）进行泄漏检测的医院执行的程序。常规检测医院复合不良事件（CAE）（意外术后干预和/或院内死亡）的校正优势比3449例患者（平均[SD]年龄58.8[14.8]岁，女性55.0%），CAE率为5.5%。随着时间的推移，挑逗性泄漏测试增加了（从第一季度的56%增加到第16季度的76%），CAE的总体比率下降了（从第一季度的7.0%下降到第16季度的4.6%,P≤0.01）。在医院进行常规泄漏检测的患者中，我们发现CAEs调整风险降低了75%以上（优势比0.23;95% CI 0.05-0.99）。左侧结直肠吻合器的常规泄漏检测似乎与SCOAP网络中cae发生率的降低有关，并且符合许多有价值的质量改进指标的标准。
To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined. Observational, prospectively designed cohort study. Data from Washington state’s Surgical Care and Outcomes Assessment Program (SCOAP). Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009. Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥90% use) in a given calendar quarter. Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals. Among 3449 patients (mean [SD] age, 58.8[14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05–0.99). Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric.
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影响因子：
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作者：
Suding, Paul;Jensen, Erin;Wilson, Samuel Eric
通讯作者：
Wilson, Samuel Eric
影响因子：
9.6
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BEARD, JD;NICHOLSON, ML;EVERSON, NW
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EVERSON, NW
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DEYO, RA;CHERKIN, DC;CIOL, MA
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CIOL, MA
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通讯作者：
KEARNEY, G
影响因子：
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作者：
Flum, DR;Dellinger, EP;Koepsell, T
通讯作者：
Koepsell, T