Closure of defunctioning loop ileostomy is associated with considerable morbidity
Closure of defunctioning loop ileostomy is associated with considerable morbidity
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DOI：
10.1111/codi.12029
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发表时间：
2013-04-01
影响因子：
3.4
通讯作者：
Fleming, F. J.
中科院分区：
文献类型：
--
作者：
Sharma, A.;Deeb, A-P;Fleming, F. J.
目的选择性去功能性回肠造口常用于减少远端吻合口瘘的发生。由于许多数据来自小系列，因此难以估计与后续回肠造口闭合相关的风险程度。本研究观察了大量患者的并发症发生率和预测因素。方法对2005年至2010年期间选择性闭合回肠造口的患者进行国家手术质量改进计划数据库查询。记录患者人口统计学资料、术前风险因素和手术变量。主要结局是30天内发生的重大（死亡、败血症、返回手术室、肾衰竭、重大心脏、神经或呼吸事件）或轻微（伤口感染、尿路感染）并发症。采用单因素和多因素回归分析这些临床因素对并发症发生率的影响。结果5401例患者行回肠造口闭合术，其中502例（9.3%）发生严重并发症。轻微并发症的发生率为8.4%（452例患者）。死亡32例（0.6%）。美国麻醉医师协会分级、功能状态、手术时间延长、慢性阻塞性肺疾病史、透析和播散性癌症是主要并发症的独立预测因素。80岁以上患者的并发症发生率没有显著增加。严重并发症与术后住院时间显著增加相关（13.9 vs 4.7天，P
Aim An elective defunctioning ileostomy is commonly employed to attenuate the morbidity that may arise from distal anastomotic leakage. The magnitude of risk associated with subsequent ileostomy closure is difficult to estimate as many of the data arise from small series. This study looked at the rate of complications and predictive factors in a large series of patients. Methods The National Surgical Quality Improvement Program database was queried for patients who had an elective closure of ileostomy between 2005 and 2010. Patient demographics, preoperative risk factors and operative variables were recorded. The primary outcome was occurrence of major (mortality, sepsis, return to the operating room, renal failure, major cardiac, neurological or respiratory episode) or minor (wound infection, urinary tract infection) complications within 30days. Univariate and multivariate regression was used to evaluate the effect of these clinical factors on the complication rate. Results In total, 5401 patients underwent closure of ileostomy, of whom 502 (9.3%) patients had major complications. The incidence of minor complications was 8.4% (452 patients). There were 32 (0.6%) deaths. American Society of Anesthesiologists grade, functional status, prolonged operative time, history of chronic obstructive pulmonary disease, dialysis and disseminated cancer were independent predictors of major complications. There was no significant increase in complication rates in patients over the age of 80. Major complications were associated with a significant increase in postoperative stay (13.9 vs 4.7days, P