虚弱对可疑胆固醇结石病的管理的影响
Katherine C Bergus1, Rondi B Gelbard2, Sara Scarlet1
1Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
The American surgeon
|July 28, 2023
概括
患有常见胆道结石 (CDL) 的脆弱患者经常偏离ASGE-SAGES指南,但并没有增加并发症. 未来的指导方针应纳入脆弱性评估,以实现最佳的CDL管理.
科学领域:
- 胃肠病学 胃肠病学
- 手术管理的手术管理.
- 患者脆弱性的评估
背景情况:
- 目前ASGE-SAGES关于胆固醇病 (CDL) 管理的指导方针不考虑患者特异性因素,如虚弱.
- 这项研究调查了在现有指导方针范围内进行同一入院胆囊切除术的CDL虚弱患者的管理.
研究的目的:
- 评估在脆弱患者和非脆弱患者中对CDL管理的ASGE-SAGES指南的遵守情况.
- 为了确定脆弱性是否会影响为CDL进行胆囊切除术的患者的指导偏差率.
主要方法:
- 分析了844名患有CDL和/或急性胆道胰腺炎 (ABP) 的患者,他们在12个美国学术医疗中心 (2016-2019) 接受了同一入院胆囊切除术.
- 用查尔森并发症指数将患者分为非脆弱 (NF),中度脆弱 (MF) 和严重脆弱 (SF) 组.
- 实际管理与ASGE-SAGES指南建议的比较,主要结果是指南偏差率.
主要成果:
- 虚弱的患者年龄较大,更有可能出现ABP.
- 随着脆弱性严重程度的增加,准则偏差率也增加了 (41.1% NF,43.5% MF,53.6% SF;P < .006).
- 严重的脆弱性独立预测的指导标准偏差 (aOR1.47与MF,aOR1.46与NF;P=0.04两者),在手术部位感染,胆道泄漏或30天再入院方面没有显著差异.
结论:
- 患有CDL的脆弱患者在同一入院胆囊切除术期间经历了更高的指导偏差率.
- 尽管偏差增加,但虚弱与手术并发症或再入院率较高无关.
- 建议将脆弱性评估纳入未来的指导方针,以优化脆弱患者群体中CDL管理.
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