Assessing the Optimal Surgical Approach for Complicated Diverticulitis in the Emergency Setting: Results from a Cohort Study Using National Surgical Quality Improvement Program Database.

IF 1.1 4区 医学 Q3 SURGERY
Rodrigo Moises de Almeida Leite, Rocco Ricciardi, Joh Hama, Isabela Monforte Toledo, Ana Sarah Portilho, Lucas de Araujo Horcel, Rafael Vaz Pandini, Lucas Cata Preta Stolzemburg, Lucas Soares Gerbasi, Francisco Tustumi, Victor Edmond Seid, Sergio Eduardo Alonso Araujo
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引用次数: 0

Abstract

Background: The optimal surgical approach for complicated diverticulitis in the emergency setting remains controversial. This retrospective cohort study aimed to investigate the clinical outcomes associated with Hartmann's procedure (HP) and primary anastomosis (with and without ileostomy) in patients diagnosed with complicated diverticulitis. Methods: Data were collected from the American College of Surgeons-National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 25,458 patients with acute diverticulitis and emergency surgery were included. The patients were categorized into three groups: those who underwent HP, those who underwent primary anastomosis with ileostomy and those who underwent primary anastomosis without ileostomy. The primary outcomes assessed were medical-related morbidity and anastomotic leak. Secondary outcomes included mortality, unplanned readmission, and length of in-hospital stay. Results: Compared to patients who underwent the primary anastomosis procedure, the HP group displayed significantly higher rates of medical-related morbidity, and higher mortality rates, even after multivariate adjustment and propensity score analysis. Patients who received the ileostomy exhibited a statistically significantly higher medical-related morbidity and unplanned readmission rates. However, aside from these outcomes, the two groups did not exhibit significantly different rates in any of the other outcomes studied, including anastomotic leak. In patients with septic shock, primary anastomosis without diverting loop ileostomy was associated with significantly lower unplanned readmission when compared with the ileostomy group. Conclusion: Primary anastomosis demonstrated superior outcomes when compared with HP, and there are potential benefits of avoiding a diverting loop ileostomy. Hemodynamical status was not associated with worse prognosis in the primary anastomosis group.

评估急诊复杂憩室炎的最佳手术方法:来自国家手术质量改进计划数据库的队列研究结果。
背景:急诊复杂憩室炎的最佳手术入路仍有争议。本回顾性队列研究旨在探讨哈特曼手术(HP)和一期吻合(伴或不伴回肠造口)在诊断为复杂性憩室炎患者中的临床结果。方法:数据收集自2016年至2021年美国外科医师学会-国家外科质量改进计划参与者用户文件。共纳入25,458例急性憩室炎和急诊手术患者。将患者分为三组:HP组、一期吻合术合并回肠造口组和一期吻合术不造口组。评估的主要结局是医学相关的发病率和吻合口漏。次要结局包括死亡率、意外再入院和住院时间。结果:与接受初级吻合手术的患者相比,HP组显示出明显更高的医学相关发病率和更高的死亡率,即使经过多因素调整和倾向评分分析。接受回肠造口术的患者在统计学上表现出更高的医疗相关发病率和计划外再入院率。然而,除了这些结果外,两组在研究的任何其他结果(包括吻合口漏)中没有表现出显着差异。在脓毒性休克患者中,与回肠造口组相比,一期吻合术不进行回肠转流袢造口可显著降低意外再入院率。结论:与HP相比,一期吻合术表现出更好的结果,并且避免转袢回肠造口有潜在的好处。原发性吻合组血流动力学状态与预后无相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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