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.
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。