随着腹壁重建术的推进,更复杂的疝气患者正在接受修补术,可能需要接受术后外科重症监护病房(SICU)治疗.疝囊与腹腔的体积比(VR)是一种易于量化疾病严重程度和随之而来的生理损伤的方法。这项研究旨在使用VR和其他术前变量来预测术后SICU的入院情况。
对2014年9月至2019年10月接受大型腹部疝(宽度≥18cm)修复的患者进行了单中心回顾性研究。患者人口统计学,合并症,腹部手术史,通过单变量和多变量方法分析和VR,以确定术后前2天内SICU入院的预测因素.生成并验证了预测模型。
在符合纳入标准的434名患者中,127(29%)在术后前两天内需要SICU入院。SICU患者的VR明显更高(中位数30.6%[IQR14.4-59.0]vs.10.6%[IQR4.35-23.6],P<0.001)。男性,慢性阻塞性肺疾病史,在组件分离之前,复发性切口疝,疝气3级和VR显示SICU入院的几率较高。在测试数据集上验证时,这些变量显示了强大的SICU入院预测,曲线下有一个面积,灵敏度,特异性分别为0.82、81.7%和68.5%,分别。
体积比与术前可用变量相结合可以可靠地预测腹壁重建后的术后SICU入院。术前预测此类事件可以分配床位空间并优化术后护理。
With the advancement of abdominal wall reconstruction, more complex hernia patients are undergoing repairs that may require a postoperative surgical intensive care unit (SICU) admission. The volume ratio (VR) of the hernia sac to the abdominal cavity is an easily applied method to quantify disease severity and the ensuing physiologic insult. This study aimed to predict postoperative SICU admission using VR and other preoperative variables.
A single-center retrospective review was conducted for patients undergoing large abdominal hernias (width ≥ 18 cm) repaired from September 2014 to October 2019. Patient demographics, comorbidities, abdominal surgical history, and VR were analyzed through univariate and multivariable methods to identify predictors of SICU admission within the first two postoperative days. A predictive model was generated and validated.
Of 434 patients meeting inclusion criteria, 127(29%) required a SICU admission within the first two postoperative days. VR was significantly higher in SICU patients (Median 30.6% [IQR 14.4-59.0] vs. 10.6% [IQR 4.35-23.6], P < 0.001). Male sex, history of chronic obstructive pulmonary disease, prior component separation, recurrent incisional hernia, hernia grade 3, and VR showed higher odds of SICU admission. When validated on a testing dataset, these variables showed strong SICU admission predictions, with an area under the curve, sensitivity, and specificity of 0.82, 81.7% and 68.5%, respectively.
The volume ratio in combination with preoperatively available variables can reliably predict postoperative SICU admission following abdominal wall reconstruction. Anticipating such events preoperatively allows for bed space allocation as well as optimizing postoperative care.