{"title":"依赖性功能状态是结肠切除术后 30 天死亡率和发病率的独立风险因素：美国 ACS-NSQIP 研究。","authors":"Renxi Li","doi":"10.1016/j.clinre.2024.102391","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus.</p></div><div><h3>Materials and method</h3><p>National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression.</p></div><div><h3>Results</h3><p>There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37–2.038, <em>p</em> < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85–2.536, <em>p</em> < 0.01), sepsis (aOR=1.31, 95 CI=1.107–1.551, <em>p</em> < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269–1.626, <em>p</em> < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23–4.411, <em>p</em> < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007–1.42, <em>p</em> = 0.04). Moreover, DFS patients had a longer length of stay (<em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.</p></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"48 7","pages":"Article 102391"},"PeriodicalIF":2.6000,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dependent functional status is an independent risk factor for 30-day mortality and morbidities following colectomy for volvulus: An ACS-NSQIP study from the United States\",\"authors\":\"Renxi Li\",\"doi\":\"10.1016/j.clinre.2024.102391\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus.</p></div><div><h3>Materials and method</h3><p>National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression.</p></div><div><h3>Results</h3><p>There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37–2.038, <em>p</em> < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85–2.536, <em>p</em> < 0.01), sepsis (aOR=1.31, 95 CI=1.107–1.551, <em>p</em> < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269–1.626, <em>p</em> < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23–4.411, <em>p</em> < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007–1.42, <em>p</em> = 0.04). Moreover, DFS patients had a longer length of stay (<em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.</p></div>\",\"PeriodicalId\":10424,\"journal\":{\"name\":\"Clinics and research in hepatology and gastroenterology\",\"volume\":\"48 7\",\"pages\":\"Article 102391\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-06-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinics and research in hepatology and gastroenterology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2210740124001128\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinics and research in hepatology and gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2210740124001128","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Dependent functional status is an independent risk factor for 30-day mortality and morbidities following colectomy for volvulus: An ACS-NSQIP study from the United States
Objectives
Colonic volvulus is a common cause of bowel obstructions and surgery is the definitive treatment. Functional status is often associated with adverse postoperative outcomes but its effect on colectomy for volvulus remained under-explored. This study sought to analyze the effect of functional status on the 30-day outcomes of colectomy for volvulus.
Materials and method
National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2022 was utilized. Only patients with volvulus as the primary indication for colectomy were included. Thirty-day postoperative outcomes were compared between patients with dependent functional status (DFS) and independent functional status (IFS), adjusted for demographics, baseline characteristics, preoperative preparation, indication for surgery, and operative approaches by multivariable logistic regression.
Results
There were 1,476 patients with DFS (945 partially DFS and 531 fully DFS) and 8,824 (85.67 %) IFS patients who underwent colectomy for volvulus. After multivariable analysis, DFS patients had higher risks of mortality (aOR=1.671, 95 CI=1.37–2.038, p < 0.01), pulmonary complications (aOR=2.166, 95 CI=1.85–2.536, p < 0.01), sepsis (aOR=1.31, 95 CI=1.107–1.551, p < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR=1.436, 95 CI=1.269–1.626, p < 0.01), discharge not to home (aOR=3.774, 95 CI=3.23–4.411, p < 0.01), and 30-day readmission (aOR=1.196, 95 CI=1.007–1.42, p = 0.04). Moreover, DFS patients had a longer length of stay (p = 0.01).
Conclusion
DFS was identified as an independent risk factor for increased mortality and complications after colectomy for volvulus. Given the substantial overlap between DFS patients and those who have colonic volvulus, these insights can contribute to preoperative risk assessments and postoperative care in these patients.
期刊介绍：
Clinics and Research in Hepatology and Gastroenterology publishes high-quality original research papers in the field of hepatology and gastroenterology. The editors put the accent on rapid communication of new research and clinical developments and so called "hot topic" issues. Following a clear Editorial line, besides original articles and case reports, each issue features editorials, commentaries and reviews. The journal encourages research and discussion between all those involved in the specialty on an international level. All articles are peer reviewed by international experts, the articles in press are online and indexed in the international databases (Current Contents, Pubmed, Scopus, Science Direct).
Clinics and Research in Hepatology and Gastroenterology is a subscription journal (with optional open access), which allows you to publish your research without any cost to you (unless you proactively chose the open access option). Your article will be available to all researchers around the globe whose institution has a subscription to the journal.
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