Abstract：
OBJECTIVE: Patients with peripheral artery disease (PAD) often require treatment with open lower extremity revascularization (LER). Patients with PAD often have other comorbidities and associated conditions that affect procedural outcomes, including abdominal stomas. The aim of this work is to investigate the impact that stomas may have on postoperative outcomes and complications.
METHODS: We performed a 5-year (2016-2020) analysis of the Nationwide Readmission Database. We identified all adult patients undergoing open LER. These patients were categorized into 2 groups: stoma and no-stoma. Propensity score matching (1:1) was used to control for demographics and comorbidities. Index admission outcomes and readmission rate were examined.
RESULTS: 212,275 open LER patients were identified. A matched cohort of 3088 patients (1:1 stoma vs no-stoma) was obtained. Patients with stomas had higher rates of several postoperative complications: acute posthemorrhagic anemia (29.1%, P < 0.01), acute kidney injury (21.4%, P < 0.001), index sepsis (10.3%, P < 0.001), and index SSI (2.8%, P < 0.001). There were no significant statistical differences between the 2 groups for acute myocardial infarction. Those with stomas had worse outcomes: greater in-hospital mortality (4.7%, P < 0.05), length of stays (median 7 days, P < 0.001), total charges (median 108,037 dollars, P < 0.001), discharges to long-term care facilities (30.8%, P < 0.001), discharges to their own homes needing home health care (30.1%, P < 0.001), 30-day readmission rates (23.2%, P < 0.01), and 30-day readmission mortality (6.1%, P < 0.01).
CONCLUSIONS: Concurrent abdominal stoma is associated with increased postoperative morbidity and mortality after open LER. Further prospective studies are needed to validate these results.
METHODS: We performed a 5-year (2016-2020) analysis of the Nationwide Readmission Database. We identified all adult patients undergoing open LER. These patients were categorized into 2 groups: stoma and no-stoma. Propensity score matching (1:1) was used to control for demographics and comorbidities. Index admission outcomes and readmission rate were examined.
RESULTS: 212,275 open LER patients were identified. A matched cohort of 3088 patients (1:1 stoma vs no-stoma) was obtained. Patients with stomas had higher rates of several postoperative complications: acute posthemorrhagic anemia (29.1%, P < 0.01), acute kidney injury (21.4%, P < 0.001), index sepsis (10.3%, P < 0.001), and index SSI (2.8%, P < 0.001). There were no significant statistical differences between the 2 groups for acute myocardial infarction. Those with stomas had worse outcomes: greater in-hospital mortality (4.7%, P < 0.05), length of stays (median 7 days, P < 0.001), total charges (median 108,037 dollars, P < 0.001), discharges to long-term care facilities (30.8%, P < 0.001), discharges to their own homes needing home health care (30.1%, P < 0.001), 30-day readmission rates (23.2%, P < 0.01), and 30-day readmission mortality (6.1%, P < 0.01).
CONCLUSIONS: Concurrent abdominal stoma is associated with increased postoperative morbidity and mortality after open LER. Further prospective studies are needed to validate these results.
摘要：
目的：外周动脉疾病（PAD）患者通常需要开放下肢血运重建（LER）治疗。PAD患者通常有其他合并症和相关疾病，影响手术结果。包括腹部气孔.这项工作的目的是研究气孔可能对术后结果和并发症的影响。
方法：我们对全国再入院数据库进行了为期5年（2016-2020年）的分析。我们确定了所有接受开放式LER的成年患者。这些患者分为两组：造口和无造口。倾向评分匹配（1：1）用于控制人口统计学和合并症。检查了指数入院结果和再入院率。
结果：确认了212,275例开放性LER患者。获得了3088名患者的匹配队列(1:1造口与无造口)。造口患者术后并发症发生率较高：急性出血后贫血（29.1%，P<0.01),急性肾损伤（21.4%，P<0.001)，指数败血症（10.3%，P<0.001)，和SSI指数（2.8%，P<0.001)。急性心肌梗死两组间差异无统计学意义。那些有气孔的人有更糟糕的结果：住院死亡率更高(4.7%，P<0.05),住院时间(中位数7天，P<0.001)，总费用(中位数为108,037美元，P<0.001)，长期护理机构出院(30.8%，P<0.001)，出院到需要家庭保健的家中(30.1%，P<0.001)，30天再入院率（23.2%，P<0.01),和30天再入院死亡率(6.1%，P<0.01)。
结论：腹部并发造口与开放性LER术后发病率和死亡率增加相关。需要进一步的前瞻性研究来验证这些结果。
方法：我们对全国再入院数据库进行了为期5年（2016-2020年）的分析。我们确定了所有接受开放式LER的成年患者。这些患者分为两组：造口和无造口。倾向评分匹配（1：1）用于控制人口统计学和合并症。检查了指数入院结果和再入院率。
结果：确认了212,275例开放性LER患者。获得了3088名患者的匹配队列(1:1造口与无造口)。造口患者术后并发症发生率较高：急性出血后贫血（29.1%，P<0.01),急性肾损伤（21.4%，P<0.001)，指数败血症（10.3%，P<0.001)，和SSI指数（2.8%，P<0.001)。急性心肌梗死两组间差异无统计学意义。那些有气孔的人有更糟糕的结果：住院死亡率更高(4.7%，P<0.05),住院时间(中位数7天，P<0.001)，总费用(中位数为108,037美元，P<0.001)，长期护理机构出院(30.8%，P<0.001)，出院到需要家庭保健的家中(30.1%，P<0.001)，30天再入院率（23.2%，P<0.01),和30天再入院死亡率(6.1%，P<0.01)。
结论：腹部并发造口与开放性LER术后发病率和死亡率增加相关。需要进一步的前瞻性研究来验证这些结果。
