Abstract：
OBJECTIVE: 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.
METHODS: 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).
CONCLUSIONS: 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.
METHODS: 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).
CONCLUSIONS: 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.
摘要：
目的：结肠扭转是肠梗阻的常见原因，手术是最终的治疗方法。功能状态通常与术后不良结局有关，但其对肠扭转结肠切除术的影响仍未得到充分研究。这项研究旨在分析功能状态对肠扭转结肠切除术30天结局的影响。
方法：使用2012年至2022年的国家外科质量改进计划（NSQIP）靶向结肠切除术数据库。仅包括将肠扭转作为结肠切除术的主要指征的患者。术后30天的结果比较患者的依赖功能状态（DFS）和独立功能状态（IFS），根据人口统计进行调整，基线特征，术前准备,手术指征,和手术方法的多变量逻辑回归。
结果：有1,476例DFS患者（945例部分DFS和531例完全DFS）和8,824例（85.67％）IFS患者接受了肠扭转结肠切除术。经过多变量分析，DFS患者死亡风险较高(aOR=1.671,95CI=1.37-2.038,p<0.01),肺部并发症（aOR=2.166，95CI=1.85-2.536，p<0.01），脓毒症（aOR=1.31，95CI=1.107-1.551，p<0.01），术后延长口服（NPO）或鼻胃管（NGT）使用（aOR=1.436，95CI=1.269-1.626，p<0.01），出院不回家(AOR=3.774，95CI=3.23-4.411，p<0.01)，30天再入院（aOR=1.196，95CI=1.007-1.42，p=0.04）。此外，DFS患者的住院时间更长（p=0.01）。
结论：DFS是结肠扭转术后死亡率和并发症增加的独立危险因素。鉴于DFS患者和结肠扭转患者之间存在大量重叠，这些见解有助于这些患者的术前风险评估和术后护理.
方法：使用2012年至2022年的国家外科质量改进计划（NSQIP）靶向结肠切除术数据库。仅包括将肠扭转作为结肠切除术的主要指征的患者。术后30天的结果比较患者的依赖功能状态（DFS）和独立功能状态（IFS），根据人口统计进行调整，基线特征，术前准备,手术指征,和手术方法的多变量逻辑回归。
结果：有1,476例DFS患者（945例部分DFS和531例完全DFS）和8,824例（85.67％）IFS患者接受了肠扭转结肠切除术。经过多变量分析，DFS患者死亡风险较高(aOR=1.671,95CI=1.37-2.038,p<0.01),肺部并发症（aOR=2.166，95CI=1.85-2.536，p<0.01），脓毒症（aOR=1.31，95CI=1.107-1.551，p<0.01），术后延长口服（NPO）或鼻胃管（NGT）使用（aOR=1.436，95CI=1.269-1.626，p<0.01），出院不回家(AOR=3.774，95CI=3.23-4.411，p<0.01)，30天再入院（aOR=1.196，95CI=1.007-1.42，p=0.04）。此外，DFS患者的住院时间更长（p=0.01）。
结论：DFS是结肠扭转术后死亡率和并发症增加的独立危险因素。鉴于DFS患者和结肠扭转患者之间存在大量重叠，这些见解有助于这些患者的术前风险评估和术后护理.
