Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction
Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction
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DOI：
10.1016/j.jss.2014.05.041
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发表时间：
2014-12-01
影响因子：
2.2
通讯作者：
Levi, Benjamin
中科院分区：
文献类型：
--
作者：
Kozlow, Jeffrey H.;Lisiecki, Jeffrey;Levi, Benjamin
背景：带血管瓣胸骨重建是胸骨伤口感染和纵隔炎治疗的核心，但有很高的并发症风险。有必要确定并发症风险的可靠预测因素，以帮助告知患者和临床医生准备手术。不幸的是，体重指数和血清白蛋白可能不是并发症发生率的可靠预测指标。分析形态组学提供了一个强大的定量方法来测量患者的肥胖，因为它涉及到他们在接受胸骨重建并发症的风险。方法：我们从1997年至2010年间进行胸骨重建的队列中选取了34例术前腹部计算机断层扫描的患者。使用半自动分析形态组学，我们确定了患者在第9和第12胸椎之间的皮肤和筋膜层；根据这些标志，我们计算了患者腹部的形态测量，包括他们的全身横截面积和皮下脂肪的横截面积。我们从图表回顾中获得并发症的发生率，并将并发症（包括血肿、血肿、复发性伤口、纵隔炎、气管造口术和死亡）的发生率与患者的形态学测量相关联。结果：术后并发症发生率为62%（21例）。与无并发症的患者相比，有并发症的患者内脏脂肪面积增加(12,547.2 mm(2)比6569.9 mm(2), P = 0.0080)，皮下脂肪面积增加(16,520.2 mm(2)比8020.1 mm(2), P = 0.0036)，全身面积增加(91,028.6 mm(2)比67,506.5 mm(2), P = 0.0022)，腹膜面积增加(69238.4 mm(2)比56,730.9 mm(2), P = 0.0118)，全身周长增加（1101.8 mm比950.2 mm, P = 0.0017），腹膜周长增加（967.5 mm比868.1 mm）。P = 0.0077)。在多元logistic回归模型中，我们还证明了上述形态学测量与并发症发生率之间存在显著的正相关，比值比为1.19-3.10 （P值为0.010-0.022）。结论：腹部形态学测量的增加与胸骨重建患者并发症的发生率密切相关。这一发现可能会影响该患者群体的术前风险分层和手术决策。(C) 2014爱思唯尔公司版权所有。
Background: Sternal reconstruction with vascularized flaps is central to the management of sternal wound infections and mediastinitis but carries a high risk of complications. There is a need to identify reliable predictors of complication risk to help inform patients and clinicians in preparation for surgery. Unfortunately, body mass index and serum albumin may not be reliable predictors of complication rates. Analytic morphomics provides a robust quantitative method to measure patients' obesity as it pertains to their risk of complications in undergoing sternal reconstruction.Methods: We identified 34 patients with preoperative computed tomography scans of the abdomen from a cohort of sternal reconstructions performed between 1997 and 2010. Using semiautomated analytic morphomics, we identified the patients' skin and fascia layers between the ninth and 12th thoracic spine levels; from these landmarks, we calculated morphomic measurements of the patients' abdomens, including their total body cross sectional area and the cross sectional area of their subcutaneous fat. We obtained the incidence of complications from chart review and correlated the incidence of complications (including seroma, hematoma, recurrent wounds, mediastinitis, tracheostomy, and death) with patients' morphomic measurements.Results: Sixty-two percent of patients (n = 21) suffered complications after their operation. Those who suffered from complications, relative to those who did not have complications, had increased visceral fat area (12,547.2 mm(2) versus 6569.9 mm(2), P = 0.0080), subcutaneous fat area (16,520.2 mm(2) versus 8020.1 mm(2), P = 0.0036), total body area (91,028.6 mm(2) versus 67,506.5 mm(2), P = 0.0022), fascia area (69,238.4 mm(2) versus 56,730.9 mm(2), P = 0.0118), total body circumference (1101.8 mm versus 950.2 mm, P = 0.0017), and fascia circumference (967.5 mm versus 868.1 mm, P = 0.0077). We also demonstrated a significant positive correlation between the previously mentioned morphomic measurements and the incidence of complications in multivariate logistic regression models, with odds ratios ranging from 1.19-3.10 (P values ranging from 0.010-0.022).Conclusions: Increases in abdominal morphomic measurements correlate strongly with the incidence of complications in patients undergoing sternal reconstruction. This finding may influence preoperative risk stratification and surgical decision making in this patient population. (C) 2014 Elsevier Inc. All rights reserved.