Can Acute Care Surgeons Perform Emergency Colorectal Procedures With Good Outcomes?
Can Acute Care Surgeons Perform Emergency Colorectal Procedures With Good Outcomes?
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DOI：
10.1097/ta.0b013e31821e43d2
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发表时间：
2011-07-01
影响因子：
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通讯作者：
Davis, Kimberly A.
中科院分区：
文献类型：
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作者：
Schuster, Kevin M.;McGillicuddy, Edward A.;Davis, Kimberly A.
背景资料：急性护理外科医生（ACS）执行紧急结直肠手术，但与普通外科和结直肠同事相比，病例量可能较低，这可能会影响结果。在急性人群中，老年人可能是在特定的risk.Methods：所有老年患者（年龄>65岁）的记录，提出了一个三级中心的结直肠急诊手术需要超过7年的时间进行了审查。提取的数据包括表现特征、术前和术后诊断、手术细节、外科医生和结局。外科医生根据他们在同一时间段内进行的择期结直肠手术的数量进行分层。采用卡方检验、Fisher精确检验和t检验，并采用Logistic回归模型控制患者特征。结果：急诊结直肠手术293例，其中急诊结直肠手术293例，急诊结直肠手术293例，急诊结直肠手术293例。围手术期危险因素分层前死亡率为15%（43/293）。ACS死亡率高于其他外科医生（23.2% vs 12.4%;比值比，2.14; p = 0.034）。ACS患者的住院时间、重症监护室住院时间和呼吸机使用天数较长，但无显著性差异。风险分层的多变量分析术前低血压，美国麻醉学会的类，年龄，手术室的时间，并与开腹技术的管理预测死亡率，但外科医生的类型doesn 't.Conclusions：ACS照顾结直肠急诊遇到危重病人有显着的合并症，往往从扩展护理设施。如果在仔细检查急诊结直肠手术的结果时考虑患者的特征，ACS的表现与进行更多选择性切除术的同事一样好。
Background: Acute care surgeons (ACS) perform emergency colorectal procedures but may have lower case volumes when compared with their general surgical and colorectal colleagues, which may compromise outcomes. In the acute populations, the elderly may be at particular risk.Methods: Records of all elderly patients (age >65 years) presenting to a tertiary center with a colorectal emergency requiring operation over a 7-year period were reviewed. Data abstracted included presenting characteristics, pre- and postoperative diagnosis, procedural details, surgeon, and outcomes. Surgeons were stratified based on the number of elective colorectal cases they performed over the same time period. Chi-square test, Fisher's exact test, and t test were used, and logistic regression models controlled for patient characteristics. p < 0.05 was significant.Results: There were 293 emergent colorectal operations. Mortality before stratification for perioperative risk factors was 15% (43 of 293). ACS mortality was higher than other surgeons (23.2% versus 12.4%; odds ratio, 2.14; p = 0.034). Length of stay, intensive care unit length of stay, and ventilator days were longer for ACS although not significant. On risk stratification by multivariate analysis preoperative hypotension, American Society of Anesthesiology class, age, time to operating room, and management with an open abdominal technique predicted mortality but surgeon type did not.Conclusions: ACS caring for colorectal emergencies encounter critically ill patients with significant comorbidities, often from extended care facilities. If patient characteristics are considered when scrutinizing outcomes of emergency colorectal procedures, ACS perform as well as their colleagues who perform a higher volume of elective resections.