纽约州粘连性小肠梗阻粘连溶解和切除术的当代评估。

IF 1.2 4区 医学 Q3 SURGERY
Surgical Innovation Pub Date : 2024-06-01 Epub Date: 2024-03-18 DOI:10.1177/15533506241240580
Matthew M Symer, Xinyan Zheng, Bradley B Pua, Art Sedrakyan, Jeffrey W Milsom
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引用次数: 0

摘要

背景:粘连性小肠梗阻(aSBO)是一种常见的外科问题,有些人主张采取更积极的手术方法以避免复发。研究对真实世界环境中的当代结果进行了考察:利用纽约州规划与研究合作数据库开展了一项回顾性队列研究,以确定 2016-2020 年期间因 aSBO 而入院的成年人。根据是否患有炎症性肠病(IBD)和癌症病史对患者进行分层。通常需要切除的诊断不包括在内。患者分为四组:非手术、粘连溶解、切除和 "其他 "手术。比较了院内死亡率、主要并发症和接受切除术的几率:结果:共纳入 58,976 名患者。结果:共纳入 58,976 名患者,其中 50,000 人(84.8%)接受了非手术治疗。粘连溶解术是最常见的手术(4990 例,8.46%),其次是切除术(3078 例,5.22%)。溶解组和切除组的院内死亡率分别为 2.2% 和 5.9%。入院当天接受手术的非 IBD 患者中有 29.9% 需要进行肠切除术。调整后的切除几率在以下人群中最高:曾发生过ASBO(OR1.29 95%CI 1.11-1.49)、手术延迟≥3天(OR1.78 95%CI 1.58-1.99)、在纽约市医院接受治疗的非纽约市(NYC)居民(OR1.57 95%CI 1.19-2.07):粘连溶解术是目前治疗 aSBO 最常见的手术,但近三分之一的患者将接受更广泛的手术,从而增加了死亡风险。需要创新疗法来降低切除风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Contemporary Assessment of Adhesiolysis and Resection for Adhesive Small Bowel Obstruction in the State of New York.

Background: Adhesive small bowel obstruction (aSBO) is a common surgical problem, with some advocating for a more aggressive operative approach to avoid recurrence. Contemporary outcomes in a real-world setting were examined.

Study design: A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative database to identify adults admitted with aSBO, 2016-2020. Patients were stratified by the presence of inflammatory bowel disease (IBD) and cancer history. Diagnoses usually requiring resection were excluded. Patients were categorized into four groups: non-operative, adhesiolysis, resection, and 'other' procedures. In-hospital mortality, major complications, and odds of undergoing resection were compared.

Results: 58,976 patients were included. 50,000 (84.8%) underwent non-operative management. Adhesiolysis was the most common procedure performed (n = 4,990, 8.46%), followed by resection (n = 3,078, 5.22%). In-hospital mortality in the lysis and resection groups was 2.2% and 5.9% respectively. Non-IBD patients undergoing operation on the day of admission required intestinal resection 29.9% of the time. Adjusted odds of resection were highest for those with a prior aSBO episode (OR 1.29 95%CI 1.11-1.49), delay to operation ≥3 days (OR1.78 95%CI 1.58-1.99), and non-New York City (NYC) residents being treated at NYC hospitals (OR1.57 95%CI 1.19-2.07).

Conclusion: Adhesiolysis is currently the most common surgery for aSBO, however nearly one-third of patients will undergo a more extensive procedure, with an increased risk of mortality. Innovative therapies are needed to reduce the risk of resection.

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来源期刊
Surgical Innovation
Surgical Innovation 医学-外科
CiteScore
2.90
自引率
0.00%
发文量
72
审稿时长
6-12 weeks
期刊介绍: Surgical Innovation (SRI) is a peer-reviewed bi-monthly journal focusing on minimally invasive surgical techniques, new instruments such as laparoscopes and endoscopes, and new technologies. SRI prepares surgeons to think and work in "the operating room of the future" through learning new techniques, understanding and adapting to new technologies, maintaining surgical competencies, and applying surgical outcomes data to their practices. This journal is a member of the Committee on Publication Ethics (COPE).
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