Postoperative Complications and Mortality Following Colectomy for Ulcerative Colitis
Postoperative Complications and Mortality Following Colectomy for Ulcerative Colitis
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DOI：
10.1016/j.cgh.2011.07.016
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发表时间：
2011-11-01
影响因子：
12.6
通讯作者：
Kaplan, Gilaad G.
中科院分区：
文献类型：
--
作者：
de Silva, Shanika;Ma, Christopher;Kaplan, Gilaad G.
背景与目的：溃疡性结肠炎 (UC) 结肠切除术后的并发症尚未在大型、基于人群的研究中得到很好的描述。我们对术后院内并发症进行了表征，按严重程度进行了分层，并评估了独立的临床预测因素，包括免疫抑制剂的使用。方法：我们使用管理数据库进行了基于人群的监测，以确定 1996 年至 2009 年间所有患有国际疾病分类第 9/10 版 UC 和结肠切除术的成年人（>= 18 岁）。对所有医疗图表进行了审查。主要结局是严重的术后并发症，包括院内死亡率。逻辑回归用于评估结肠切除术后并发症的预测因素，然后仅限于接受紧急或择期手术的患者。结果：666例接受结肠切除术的UC患者中，术后并发症发生率为27.0%，死亡率为1.5%。术后并发症的独立预测因素是年龄（>64岁与18 -34岁的患者：比值比[OR]，1.95；95%置信区间[CI]，1.07-3.54）、合并症（>2与无：OR，1.89；95% CI，1.06 3.37）和入院状态（紧急与择期结肠切除术：OR， 1.62；95% CI，1.14-2.30）。紧急结肠切除术的重要危险因素包括从入院到结肠切除术的时间（>14 与 3-14 天：OR，3.32；95% CI，1.62-6.80）和术前并发症（>= 1 vs 0：OR，3.04；95% CI，1.33-6.91）。结肠切除术前服用免疫抑制剂并不会增加术后并发症的风险。结论：UC 结肠切除术后经常发生术后并发症，主要发生在患有多种合并症的老年患者中。在紧急情况下入院且对药物治疗无反应的患者在入院 14 天或更长时间后进行手术时，结果会更差。
BACKGROUND & AIMS: Complications after colectomy for ulcerative colitis (UC) have not been well characterized in large, population-based studies. We characterized postoperative in-hospital complications, stratified them by severity, and assessed independent clinical predictors, including use of immunosuppressants. METHODS: We performed population-based surveillance using administrative databases to identify all adults (>= 18 y) who had an International Classification of Diseases-9th/10th revisions code for UC and a colectomy from 1996 to 2009. All medical charts were reviewed. The primary outcome was severe postoperative complications, including in-hospital mortality. Logistic regression was used to assess predictors of complications after colectomy and then restricted to patients undergoing emergent or elective surgeries. RESULTS: Of the 666 UC patients who underwent a colectomy, a postoperative complication occurred in 27.0% and the mortality rate was 1.5%. Independent predictors of postoperative complications were age (for patients >64 vs 18 -34 y: odds ratio [OR], 1.95; 95% confidence interval [CI], 1.07-3.54), comorbidities (>2 vs none: OR, 1.89; 95% CI, 1.06 3.37), and admission status (emergent vs elective colectomy: OR, 1.62; 95% CI, 1.14-2.30). Significant risk factors for an emergent colectomy included time from admission to colectomy (>14 vs 3-14 d: OR, 3.32; 95% CI, 1.62-6.80) and a preoperative complication (>= 1 vs 0: OR, 3.04; 95% CI, 1.33-6.91). A prescription of immunosuppressants before colectomies did not increase the risk for postoperative complications. CONCLUSIONS: Postoperative complications frequently occur after colectomy for UC, predominantly among elderly patients with multiple comorbidities. Patients who were admitted to the hospital under emergency conditions and did not respond to medical treatment had worse outcomes when surgery was performed 14 or more days after admission.