The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures
The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures
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DOI：
10.1111/j.1463-1318.2005.00857.x
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发表时间：
2005-11-01
影响因子：
3.4
通讯作者：
Crowe, AM
中科院分区：
文献类型：
--
作者：
Parker, MC;Wilson, MS;Crowe, AM
目的手术和临床粘连研究（SCAR）和SCAR-2研究表明，下腹部手术后粘连的负担是相当大的，尽管预防粘连的策略取得了进展，但似乎保持不变。在这项研究中，我们评估了与常见下腹部手术直接相关的粘连相关再入院风险，考虑了既往手术的影响，方法来自苏格兰国家卫生服务医疗记录链接数据库的数据用于评估1996年4月至2005年12月期间开放性下腹部手术后粘连相关再入院的风险。结果接受下腹部手术（不包括阑尾切除术）的患者在术后5年内直接因粘连再入院的风险为5%。阑尾切除术与较低的再入院率（0.9%）相关，但占下腹部手术患者再入院总负担的7%以上。全直肠结肠切除术（15.4%）、全结肠切除术（8.8%）和回肠造口术（10.6%）与粘连相关再入院的风险最高。总的来说，在手术后5年内接受腹部或盆腔手术的患者再入院的风险增加了一倍。年龄≥ 60岁的患者再入院的风险也较高< 60 years compared with those aged >。性别的影响进行了评估。然而，由于发现使用的手术代码偏向于妇女，因此没有报告这些数据。合并腹膜炎患者的再入院风险略高于无腹膜炎患者。相反，克罗恩病对风险没有影响。结直肠癌患者粘连形成的风险较低。然而，这可能是由于在此患者group.Conclusion中进行的手术类型，高风险患者亚组的识别可能有助于有效地针对粘连预防策略和粘连风险的术前建议。
Objective The Surgical and Clinical Adhesions Research (SCAR) and SCAR-2 studies demonstrated that the burden of adhesions following lower abdominal surgery is considerable and appears to remain unchanged despite advances in strategies to prevent adhesions. In this study, we assessed the adhesion-related readmission risk directly associated with common lower abdominal surgical procedures, taking into account the effect of previous surgery, demography and concomitant disease.Methods Data from the Scottish National Health Service medical record linkage database were used to assess the risk of an adhesion-related readmission following open lower abdominal surgery during April 1996-March 1997.Results Patients undergoing lower abdominal surgery (excluding appendicectomy) had a 5% risk of readmission directly related to adhesions in the 5 years following surgery. Appendicectomy was associated with a lower rate of readmission (0.9%), but contributed over 7% of the total lower abdominal surgery patient readmission burden. Panproctocolectomy (15.4%), total colectomy (8.8%) and ileostomy surgery (10.6%) were associated with the highest risk of an adhesion-related readmission. Overall, the risk of readmission was doubled in patients who had undergone abdominal or pelvic surgery within 5 years of the incident operation. A higher risk of readmission was also recorded in patients aged < 60 years compared with those aged >= 60 yrs. The effect of gender was assessed. However, as the surgical codes used were found to be skewed towards women, these data have not been reported. Readmission risk was slightly higher in patients with concomitant peritonitis compared with patients without peritonitis. In contrast, Crohn's disease had no effect on risk. Patients with colorectal cancer had a lower risk of adhesion formation. However, this may have been due to the type of surgery performed in this patient group.Conclusion The identification of high-risk patient subgroups may assist in effectively targeting adhesion-prevention strategies and the proffering of preoperative advice on adhesion risk.