背景:我们研究了急性肠系膜缺血(AMI)的结局,假设开腹(OA)与死亡率降低有关。
方法:我们进行了一项队列研究,回顾了NSQIP急诊剖腹手术患者,2016-2020年,术后诊断为肠系膜缺血。对于没有筋膜闭合的患者,使用标志来定义OA。使用Logistic回归分析30天死亡率和几个次要结果。
结果:在5514例中,4624(83.9%)接受了切除术,387(7.0%)接受了血运重建。OA率为32.6%。关闭的患者中有10.8%需要再次手术。调整人口统计后,传输状态,合并症,术前变量包括肌酐,白细胞计数,贫血,以及手术时间,OA与死亡率的OR1.58相关(95%CI[1.38,1.81],p<0.001)。在血运重建中,没有这种关联(p=0.528).OA与呼吸机支持>48小时相关(OR4.04,95%CI[3.55,4.62],和p<0.001)。
结论:AMI患者的OA与死亡率增加和通气时间延长相关。在血运重建患者中情况并非如此,10例接受初次闭合的患者中有1例需要再次手术.在AMI的特定病例中应考虑OA。
方法:回顾性队列,三级。
We examined outcomes in Acute Mesenteric Ischemia (AMI) with the hypothesis that Open Abdomen (OA) is associated with decreased mortality.
We performed a cohort study reviewing NSQIP emergency laparotomy patients, 2016-2020, with a postoperative diagnosis of mesenteric ischemia. OA was defined using flags for patients without fascial closure. Logistic regression was used with outcomes of 30-day mortality and several secondary outcomes.
Out of 5514 cases, 4624 (83.9%) underwent resection and 387 (7.0%) underwent revascularization. The OA rate was 32.6%. 10.8% of patients who were closed required reoperation. After adjustment for demographics, transfer status, comorbidities, preoperative variables including creatinine, white blood cell count, and anemia, as well as operative time, OA was associated with OR 1.58 for mortality (95% CI [1.38, 1.81], p < 0.001). Among revascularizations, there was no such association (p = 0.528). OA was associated with ventilator support >48 h (OR 4.04, 95% CI [3.55, 4.62], and p < 0.001).
OA in AMI was associated with increased mortality and prolonged ventilation. This is not so in revascularization patients, and 1 in 10 patients who underwent primary closure required reoperation. OA should be considered in specific cases of AMI.
Retrospective cohort, Level III.