背景:在炎症性肠病文献中,与择期手术相比,克罗恩病(CD)的急诊手术术后预后较差.以前的研究仅比较了异质组。我们假设在匹配分析后这种关联会丢失。我们旨在比较接受择期手术与急诊手术的匹配CD患者。
方法:国家手术质量改进数据库(2005年1月12日至2019年)用于识别成人CD手术患者。使用单变量和条件逻辑回归模型来分析不匹配和匹配的队列。进行倾向评分匹配,以将急诊与非急诊患者1:1进行匹配。我们的主要结果是任何并发症的复合。我们的次要终点是再次住院,计划外的再次手术和30天的发病率和死亡率。
结果:在接受结肠切除术的克罗恩患者的未匹配分析(n=12,181/95.28%的选择性和n=603/4.72%的急诊)中,20%的择期和42%的急诊患者出现并发症(p<0.001)。测量了20多个结果,包括住院时间(LOS),重新接纳,感染和呼吸道,心血管和肾脏并发症,在急诊队列中情况更糟。在匹配的分析(n=400例急诊/400例择期患者)中,仅任何并发症的类别(OR1.44,1.06-1.9695%CI,p=0.02),任何手术部位感染(SSI,或1.53,1.07-2.1995%CI,p=0.02),浅表SSI(OR2.25,1.14-4.4495%CI,p=0.02),器官空间SSI(1.58或1.04-2.495%CI,p=0.03),非计划插管(OR5.0,1.45-17.2795%CI,p=0.01),在急诊队列中,通气>48h(OR9.0,1.4-38.79,95%CI,p=0.003)和感染性休克(OR4.5,1.86-10.9,95%CI,p<0.001)较高.
结论:匹配的CD患者导致观察到的心血管和肾脏并发症增加的损失,急诊手术后的再次手术和LOS;然而,尽管匹配,SSIs和呼吸道并发症仍然增加。
In the inflammatory bowel disease literature, emergency surgery for Crohn\'s disease (CD) is associated with worse postoperative outcomes as compared to elective surgery. Previous studies have compared heterogeneous groups only. We hypothesized that this association would be lost after matched analysis. We aimed to compare matched CD patients undergoing elective vs emergency surgery.
The National Surgical Quality Improvement database (01/2005-12/2019) was utilized to identify adult CD surgical patients. Univariate and conditional logistic regression models were used to analyze unmatched and matched cohorts. Propensity-score matching was performed to match emergency to non-emergency patients 1:1. Our primary outcome was a composite of any complication. Our secondary endpoints were hospital readmission, unplanned reoperation and 30-day morbidity and mortality.
In the unmatched analyses (n = 12,181/95.28% elective and n = 603/4.72% emergency) of Crohn\'s patients undergoing colectomy, 20% of elective and 42% of emergency patients experienced a complication (p < 0.001). Over 20 outcomes measured including length of stay (LOS), readmission, infections and respiratory, cardiovascular and renal complications, were worse in the emergency cohort. In the matched analyses (n = 400 emergency/400 elective patients) only the categories of any complication (OR 1.44, 1.06-1.96 95% CI, p = 0.02), any surgical site infection (SSI, OR 1.53, 1.07-2.19 95% CI, p = 0.02), superficial SSI (OR 2.25, 1.14-4.44 95% CI, p = 0.02), organ space SSI (1.58 OR 1.04-2.4 95% CI, p = 0.03), unplanned intubation (OR 5.0, 1.45-17.27 95% CI, p = 0.01), ventilation > 48 h (OR 9.0, 1.4-38.79 95% CI, p = 0.003) and septic shock (OR 4.5, 1.86-10.9 95% CI, p < 0.001) were higher in the emergency cohort.
Matching CD patients resulted in a loss of the observed increase in cardiovascular and renal complications, reoperation and LOS following emergency surgery; however, SSIs and respiratory complications remained increased despite matching.