Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors.
Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors.
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DOI：
10.1007/s11605-016-3195-y
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发表时间：
2016-09
期刊：
影响因子：
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通讯作者：
Zaydfudim VM
中科院分区：
文献类型：
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作者：
Martin AN;Das D;Turrentine FE;Bauer TW;Adams RB;Zaydfudim VM
胃切除术后的发病率仍然很高。潜在的可改变的危险因素还没有得到很好的描述。本研究考虑了一系列可能改变的患者特异性和围手术期特征，这些特征可能被认为可以降低胃切除术后的发病率和死亡率。这项回顾性队列研究包括ACS NSQIP PUF数据集中2011年至2013年间接受胃切除术的成年人。序贯多变量模型用于估计临床协变量对研究结果的影响，包括发病率、死亡率、再入院和再手术。3678例患者接受了胃切除术。多数患者行胃远端切除术（N= 2799, 76.1%），恶性肿瘤切除术（N= 2316, 63.0%）。798例（21.7%）出现严重并发症。290例（7.9%）患者需要再次手术。30天死亡率为5.2%。年龄（OR=1.01, 95% CI: 1.01 - 1.02, p=0.001）、术前营养不良（OR=1.65, 95% CI: 1.35-2.02, p<0.001）、全胃切除术（OR=1.63, 95% CI: 1.31-2.03, p<0.001）、良性切除指征（OR=1.60, 95% CI: 1.29-1.97, p<0.001）、输血（OR=2.57, 95% CI: 2.10-3.13, p<0.001）、术中放置饲管（OR=1.28, 95% CI: 1.00-1.62, p=0.047）与发病率增加独立相关。烟草使用与发病率之间的关联在统计学上是边际的（OR=1.23, 95% CI: 0.99-1.53, p=0.064）。全因术后发病率与再手术、再入院和死亡率显著相关（均p<0.001）。减轻围手术期危险因素，包括吸烟和营养不良，以及确定的手术考虑可能改善胃切除术后的预后。术后发病率与其他不良预后指标密切相关：再手术、再入院和死亡率。
Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission and reoperation. 3,678 patients underwent gastrectomy. A majority of patients had distal gastrectomy (N= 2,799, 76.1%) and had resection for malignancy (N= 2,316, 63.0%). 798 patients (21.7%) experienced a major complication. Reoperation was required in 290 patients (7.9%). 30-day mortality was 5.2%. Age (OR=1.01, 95% CI: 1.01–1.02, p=0.001), preoperative malnutrition (OR=1.65, 95% CI: 1.35–2.02, p<0.001), total gastrectomy (OR=1.63, 95% CI: 1.31–2.03, p<0.001), benign indication for resection (OR=1.60, 95% CI: 1.29–1.97, p<0.001), blood transfusion (OR=2.57, 95% CI: 2.10–3.13, p<0.001), and intraoperative placement of a feeding tubes (OR=1.28, 95% CI: 1.00–1.62, p=0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR=1.23, 95% CI: 0.99–1.53, p=0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p<0.001). Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.