Abstract：
BACKGROUND: We aimed to compare outcomes of surgical treatments of toxic colitis (infectious/inflammatory/ischemic) by the extent of colectomy (partial vs total colectomy) and different surgical approaches (minimally invasive surgery (MIS) vs open).
METHODS: Multivariate analysis using logistic regression was used to investigate outcomes of patients with toxic colitis who underwent emergent colectomy during 2012-2019 by surgical approach and the extent of resection using NSQIP database.
RESULTS: Overall, 2,104 adult patients underwent emergent colectomy for toxic colitis within NSQIP database during 2012-2019. Overall, 1,578 (75.4%) underwent total colectomy with colostomy, 486 (23.2%) underwent partial colectomy with colostomy, and 28 (1.3%) underwent partial colectomy with anastomosis. Overall, 198 (9.4%) of procedures were minimally invasive (MIS) with a 40.1% conversion rate to open. Thirty days mortality and morbidity of the patients were 31 and 86%, respectively. There was no significant difference in mortality of partial colectomy without anastomosis compared to total colectomy (P = .86) and partial colectomy with anastomosis (P = .64). Anastomosis was associated with 32.3% anastomosis leakage and 17.9% reoperation. MIS approach was associated with significant decrease in mortality (8.6 vs 33.3%, AOR: .35, P < .01) and morbidity (62.9 vs 87.8%, AOR: .49, P < .01) of patients.
CONCLUSIONS: Patients with toxic colitis undergoing surgical treatment have high mortality and morbidity. An MIS approach when possible is significantly associated with decreased morbidity and mortality of patients. There was no significant difference in outcomes seen when extending the resection in multivariate analysis. Anastomosis is associated with a high anastomosis leakage and need for reoperation risk.
METHODS: Multivariate analysis using logistic regression was used to investigate outcomes of patients with toxic colitis who underwent emergent colectomy during 2012-2019 by surgical approach and the extent of resection using NSQIP database.
RESULTS: Overall, 2,104 adult patients underwent emergent colectomy for toxic colitis within NSQIP database during 2012-2019. Overall, 1,578 (75.4%) underwent total colectomy with colostomy, 486 (23.2%) underwent partial colectomy with colostomy, and 28 (1.3%) underwent partial colectomy with anastomosis. Overall, 198 (9.4%) of procedures were minimally invasive (MIS) with a 40.1% conversion rate to open. Thirty days mortality and morbidity of the patients were 31 and 86%, respectively. There was no significant difference in mortality of partial colectomy without anastomosis compared to total colectomy (P = .86) and partial colectomy with anastomosis (P = .64). Anastomosis was associated with 32.3% anastomosis leakage and 17.9% reoperation. MIS approach was associated with significant decrease in mortality (8.6 vs 33.3%, AOR: .35, P < .01) and morbidity (62.9 vs 87.8%, AOR: .49, P < .01) of patients.
CONCLUSIONS: Patients with toxic colitis undergoing surgical treatment have high mortality and morbidity. An MIS approach when possible is significantly associated with decreased morbidity and mortality of patients. There was no significant difference in outcomes seen when extending the resection in multivariate analysis. Anastomosis is associated with a high anastomosis leakage and need for reoperation risk.
摘要：
背景：我们的目的是通过结肠切除术的程度（部分与全结肠切除术）和不同的手术方法（微创手术（MIS）与开放）来比较中毒性结肠炎（感染性/炎性/缺血性）的手术治疗结果。
方法：使用Logistic回归的多因素分析用于调查2012-2019年期间通过手术方法进行紧急结肠切除术的中毒性结肠炎患者的结局以及使用NSQIP数据库的切除程度。
结果：总体而言，2012-2019年期间，在NSQIP数据库中，2,104例成人患者因毒性结肠炎接受了紧急结肠切除术。总的来说,1,578（75.4％）进行了结肠造口术，486例(23.2%)行部分结肠切除术伴结肠造口,28例(1.3%)行部分结肠切除术伴吻合术。总的来说,198例（9.4％）的手术为微创（MIS），开放转化率为40.1％。30天的死亡率和发病率分别为31％和86％，分别。与全结肠切除术（P=0.86）和部分结肠切除术并吻合（P=0.64）相比，不吻合结肠部分切除术的死亡率没有显着差异。吻合口瘘占32.3%，再手术占17.9%。MIS方法与死亡率显着下降相关(8.6vs33.3%，AOR：.35，P<.01）和发病率（62.9vs87.8%，AOR：.49，P<.01）患者。
结论：接受手术治疗的中毒性结肠炎患者具有较高的死亡率和发病率。在可能的情况下，MIS方法与降低患者的发病率和死亡率显着相关。在多变量分析中延长切除时，观察到的结果没有显着差异。吻合与高吻合口渗漏和需要再次手术的风险相关。
方法：使用Logistic回归的多因素分析用于调查2012-2019年期间通过手术方法进行紧急结肠切除术的中毒性结肠炎患者的结局以及使用NSQIP数据库的切除程度。
结果：总体而言，2012-2019年期间，在NSQIP数据库中，2,104例成人患者因毒性结肠炎接受了紧急结肠切除术。总的来说,1,578（75.4％）进行了结肠造口术，486例(23.2%)行部分结肠切除术伴结肠造口,28例(1.3%)行部分结肠切除术伴吻合术。总的来说,198例（9.4％）的手术为微创（MIS），开放转化率为40.1％。30天的死亡率和发病率分别为31％和86％，分别。与全结肠切除术（P=0.86）和部分结肠切除术并吻合（P=0.64）相比，不吻合结肠部分切除术的死亡率没有显着差异。吻合口瘘占32.3%，再手术占17.9%。MIS方法与死亡率显着下降相关(8.6vs33.3%，AOR：.35，P<.01）和发病率（62.9vs87.8%，AOR：.49，P<.01）患者。
结论：接受手术治疗的中毒性结肠炎患者具有较高的死亡率和发病率。在可能的情况下，MIS方法与降低患者的发病率和死亡率显着相关。在多变量分析中延长切除时，观察到的结果没有显着差异。吻合与高吻合口渗漏和需要再次手术的风险相关。
