Laparoscopy improves failure to rescue compared to open surgery for emergent colectomy
Laparoscopy improves failure to rescue compared to open surgery for emergent colectomy
复制标题
DOI：
10.1007/s13304-020-00803-9
复制
发表时间：
2020-06-09
影响因子：
2.6
通讯作者：
Merchant, Aziz M.
中科院分区：
文献类型：
--
作者：
Patel, Richa;Patel, Krishan S.;Merchant, Aziz M.
紧急结肠切除术是在成千上万的美国人每年进行，并进行显着的发病率和死亡率。虽然腹腔镜在选择性手术中得到了青睐，但其对抢救失败的影响尚未在急诊结肠切除术的人群水平上进行研究。本研究的目的是比较急诊情况下腹腔镜与开腹结肠切除术后抢救失败的情况。这是一项美国外科医师学会国家外科质量改进计划的回顾性队列研究。选择2005年至2018年期间接受紧急结肠切除术的成人患者，并使用当前手术术语代码将其分层为腹腔镜或开放手术组。根据人口统计学和合并症数据进行倾向匹配。主要结局为抢救失败、死亡率、总体发病率、个体并发症和住院时间。匹配后，11,484例病例纳入分析，其中3829例为腹腔镜手术。总体而言，开放性结肠切除术与腹腔镜手术相比，具有更高的抢救失败率（OR 1.71，95% CI 1.42-2.08）、死亡率（OR 1.72，95% CI 1.44-2.07）和发病率（OR 1.73，95% CI 1.60-1.88）。开放手术显著增加了几乎所有测量的术后并发症的风险，包括返回手术室（OR 1.25，95% CI 1.08-1.45），呼吸机使用> 48小时（OR 2.43，95% CI 2.03-2.93）和脓毒性休克（OR 2.34，95% CI 1.97-2.80）。腹腔镜结肠切除术患者的住院时间（10.4天）短于开腹结肠切除术患者（12.3天）（p < 0.0001）。本研究证明了腹腔镜方法与开放手术相比用于紧急结肠切除术的安全性和有效性。腹腔镜手术与并发症发生率、死亡率和抢救失败率的改善相关，表明它是一种有希望改善急诊结肠切除术患者结局的选择。
Emergent colectomy is performed in thousands of Americans each year and carries significant morbidity and mortality. Although laparoscopy has gained favor in the elective setting, its impact on failure to rescue has not been studied on a population level for emergent colectomy. The purpose of this study was to compare failure to rescue following laparoscopic versus open colectomy in the emergency setting. This was a retrospective cohort study of The American College of Surgeons National Surgical Quality Improvement Program. Adult patients undergoing emergent colectomy between 2005 and 2018 were selected and stratified into laparoscopic or open surgery groups using the Current Procedural Terminology codes. Propensity matching was performed based on the demographic and comorbidity data. Main outcomes were failure to rescue, mortality, overall morbidity, individual complications, and length of hospital stay. After matching, 11,484 cases were included for analysis, of which 3829 were laparoscopic. Overall, open colectomy conferred higher odds of failure to rescue (OR 1.71, 95% CI 1.42-2.08), mortality (OR 1.72, 95% CI 1.44-2.07), and morbidity (OR 1.73, 95% CI 1.60-1.88) vs laparoscopic cases. Open surgery significantly increased the risk of nearly all measured postoperative complications including return to operating room (OR 1.25, 95% CI 1.08-1.45), ventilator use > 48 h (OR 2.43, 95% CI 2.03-2.93), and septic shock (OR 2.34, 95% CI 1.97-2.80). Hospital length of stay was shorter for patients undergoing laparoscopic (10.4 days) vs open (12.3 days) colectomy (p < 0.0001). This study demonstrates the safety and efficacy of the laparoscopic approach for emergent colectomy vs open surgery. Laparoscopy was associated with improved complications rates, mortality, and failure to rescue, indicating that it is a promising option to improve patient outcomes during emergent colectomy.