小肠阻塞手术的最佳时间:利用全国性住院患者样本进行风险调整分析
Fred C Kobylarz1, Maeghan L Ciampa1, Camille R Suydam1
1Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA, USA.
The American surgeon
|June 16, 2023
概括
小肠阻塞 (SBO) 手术的最佳时间是至关重要的. 推迟入院后3-5天的手术可能会降低死亡率和心肺复杂症,尽管伤口问题略有增加.
科学领域:
- 一般外科 整体外科
- 胃肠道手术 胃肠道手术
- 手术结果研究研究.
背景情况:
- 小肠阻塞 (SBO) 管理对一般外科医生来说是一个挑战.
- 虽然大多数SBO病例都得到了保守的治疗,但最佳的外科手术时间仍然不确定.
- 这项研究评估了SBO诊断后手术干预的理想时间框架.
研究的目的:
- 确定小肠阻塞 (SBO) 患者手术干预的最佳时间.
- 分析手术前停留时间 (LOS) 与患者结果之间的关联.
- 根据手术时间确定风险调整后术后结果.
主要方法:
- 全国住院患者样本 (2006-2015) 的回顾性分析.
- 使用ICD-9-CM代码识别SBO手术.
- 根据从入院到手术的几天进行分层分组,使用倾向性得分和多变量回归分析.
主要成果:
- 对92,807次非选择性SBO手术的分析显示,整体死亡率为4.7%.
- 术后3-5天间的手术显示死亡率最低.
- 延迟干预 (≥6天) 减少了心脏和肺部并发症,而3-5天后的LOS增加了伤口和手术并发症.
结论:
- 3-5天的术前停留时间 (LOS) 与死亡风险降低有关.
- 增加手术前的LOS与心肺并发症的减少有关.
- 然而,3-5天的窗口也增加了程序和伤口并发症的风险,这表明技术挑战.
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