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系统性原因是非计划性结直肠修复手术后失败的重要风险因素
Frédéric Borie1,2,3, Clara Bourla4, Bertrand Millat4
1Fédération de Chirurgie Viscérale Et Digestive (FCVD), 12 Rue Bayard, 31000, Toulouse, France. frederic.borie@chu-nimes.fr.
Langenbeck's archives of surgery
|September 16, 2023
概括
系统性因素对结直肠外科手术后的死亡有显著的贡献. 解决这些延迟可以预防超过三分之一的死亡事故,改善患者的治疗结果.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
- 患者安全 患者安全
背景情况:
- 在结直肠手术后,非预定的修复手术 (URS) 的发生率为2.4%.
- 在结直肠外科手术中,救援手术失败率 (FTR-s) 在11-17%之间.
- 了解URS致死率对于降低术后死亡率至关重要.
研究的目的:
- 评估结肠直肠手术后与非计划修复手术 (URS) 相关的死亡原因.
- 确定导致URS延迟和随后救援失败的系统因素.
- 为旨在减少URS相关死亡的战略提供数据.
主要方法:
- 一个由337名外科医生收集的547例URS病例的10年回顾性分析 (2011-2021年).
- 在URS后对死亡风险因素 (FTR-s) 的多变量分析,包括程序类型,时间,诊断和延迟原因.
- 分析系统性延迟因素:紧急性评估,沟通,技能,行动计划组织和运输.
主要成果:
- 感染原因 (66%) 和血管问题 (18%) 是URS的主要原因.
- 救援手术 (FTR-s) 的整体失败率为10%,系统性原因占FTR的35%.
- FTR与患者因素 (ASA分数,年龄),手术方法 (拉巴切除术) 和系统性延迟URS实现 (RR:4.1) 有关.
结论:
- 避免系统性延迟无计划修复手术的原因,可以预防超过三分之一的死亡.
- 改善沟通和组织等系统因素是减少结直肠手术后救援失败的关键.
- 针对系统性问题提供了一个显著的机会,以提高后结直肠手术后的生存率.
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