目的:关于白细胞减少症患者肛门直肠脓肿的处理,现有资料很少。这项研究的目的是探讨肛门直肠脓肿切开引流术患者白细胞减少的影响。
方法:对美国外科医师学会国家外科质量改善计划(ACS-NSQIP)数据库的回顾性审查确定了2015年至2020年的患者。排除肛周瘘和肾上脓肿。根据白细胞(WBC)计数对患者进行分组:WBC<4.5细胞/μl,WBC=4.5-11.0细胞/μl且WBC>11.0细胞/μl。使用回归模型比较30天的总体并发症和结果,考虑人口统计和合并症。
结果:确认了一万名患者(男性占70.3%)。单因素分析表明,与白细胞增多(WBC>11.0细胞/μl)和正常WBC计数(WBC=4.5-11.0细胞/μl)的患者相比,白细胞减少症患者(WBC<4.5细胞/μl)的总体发生率较高(p<0.001),肺(p<0.001)和血液并发症(p<0.001)。他们也有更高的再入院率(p<0.001),再手术(p=0.005),出院到护理机构(p=0.003),住院时间(p=0.004)和死亡(p<0.001)。多变量分析确定白细胞减少是总体并发症的独立危险因素[比值比(OR)2.31,95%CI1.65-3.24;p<0.001],肺部并发症(OR5.65,95%CI1.88-16.97;p=0.002),血液学并发症(OR4.30,95%CI2.94-6.28;p<0.001),计划外再入院(OR2.20,95%CI1.43-3.40;p<0.001),再手术(OR1.80,95%CI1.10-2.93;p=0.019)和死亡(OR2.77,95%CI1.02-7.52;p=0.046)。在多变量分析中,出院到护理机构和住院时间并不显着。
结论:白细胞减少与肺部和血液并发症的风险增加有关。再入院,重新操作,肛门直肠脓肿切开引流术后出院至护理机构并死亡。
Few data are available regarding the management of anorectal abscess in patients with leukopenia. The aim of this study was to investigate the impact of leukopenia among patients undergoing incision and drainage for anorectal abscess.
A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. Perianal fistulas and supralevator abscesses were excluded. Patients were grouped based on white blood cell (WBC) count: WBC < 4.5 cells/μl, WBC = 4.5-11.0 cells/μl and WBC > 11.0 cells/μl. The 30-day overall complications and outcomes were compared using regression models, accounting for demographics and comorbidities.
Ten thousand two hundred and forty (70.3% male) patients were identified. Univariate analysis showed that, compared with patients with leukocytosis (WBC > 11.0 cells/μl) and normal WBC count (WBC = 4.5-11.0 cells/μl), patients with leukopenia (WBC <4.5 cells/μl) had higher rates of overall (p < 0.001), pulmonary (p < 0.001) and haematological complications (p < 0.001). They also had higher rates of readmission (p < 0.001), reoperation (p = 0.005), discharge to a care facility (p = 0.003), increased length of hospital stay (p = 0.004) and death (p < 0.001). Multivariable analysis identified leukopenia as an independent risk factor for overall complications [odds ratio (OR) 2.31, 95% CI 1.65-3.24; p < 0.001], pulmonary complications (OR 5.65, 95% CI 1.88-16.97; p = 0.002), haematological complications (OR 4.30, 95% CI 2.94-6.28; p < 0.001), unplanned readmission (OR 2.20, 95% CI 1.43-3.40; p < 0.001), reoperation (OR 1.80, 95% CI 1.10-2.93; p = 0.019) and death (OR 2.77, 95% CI 1.02-7.52; p = 0.046). Discharge to a care facility and length of stay were not significant on multivariable analysis.
Leukopenia is associated with increased risk for pulmonary and haematological complications, readmissions, reoperations, discharge to a care facility and death after incision and drainage for anorectal abscess.