切断与30天的无计划再入院和伤口并发症相比,对于EVAR的皮肤通道接入,切断与更高的30天的无计划再入院和伤口并发症有关
Meagan Read1, Trung Nguyen2, Kevin Swan2
1Division of Vascular and Endovascular Surgery, University of South Florida, Tampa, FL; Division of GI Oncology, Moffitt Cancer Center, Tampa, FL.
Annals of vascular surgery
|April 10, 2024
概括
对于内血管大动脉动脉瘤修复 (EVAR),完全通过皮肤的访问与较低的30天再入院率有关. 削减方法,特别是双边方法,显示了再入院和伤口并发症的更高风险,建议在可行的情况下优先考虑穿皮方法.
科学领域:
- 血管外科 血管外科
- 医疗设备接入技术 医疗设备接入技术
- 健康 结果 研究 研究 结果
背景情况:
- 关于内血管大动脉动脉瘤修复 (EVAR) 中的股骨接入并发症存在相互矛盾的证据.
- 虽然一些评论显示没有差异,但单中心研究表明,由于伤口感染,双边切断的再入院率更高.
- 不同的EVAR访问策略之间的30天再接收风险的比较仍然不清楚.
研究的目的:
- 为了确定EVAR.最佳的股骨接入策略.
- 确定与30天计划外再接收的最低风险相关的EVAR访问方法.
- 为了比较穿皮和切割EVAR接入方法之间的再接收和伤口并发症率.
主要方法:
- 美国外科医生学院国家外科质量改善计划针对性血管模块 (2012-2021) 的分析.
- 排除紧急情况和破裂.
- 将患者分为队列的分类:双边切断,单边切断,未能通过皮肤进行开放转换和成功通过皮肤接入.
- 主要结局:30天的无计划再入院和伤口并发症.
- 使用费舍尔的精确测试,奇平方测试,学生的t测试和多变量逻辑回归的统计分析.
主要成果:
- 总共分析了14002名患者.
- 在53%的病例中,完全采用皮肤切割的方法,其次是双边切割 (40%),单边切割 (6%) 和未能采用皮肤切割的方法 (1%).
- 在30天内,再入院率为穿皮治疗5.7%,单边切割7.3%,双边切割7.6%,穿皮转换失败7.8% (P < 0.001).
- 多变量分析显示,与穿皮治疗相比,双边切割与明显更高的再入院 (AOR:1.26,P = 0.001) 和伤口并发症 (AOR:4.41,P < 0.001) 相关.
结论:
- 通过切断接入接受EVAR的患者面临的30天再入院的风险较高,与皮肤穿透接入患者相比.
- 当患者的解剖学允许时,建议优先进行皮肤穿的EVAR.
- 削减方法,特别是双边的,与增加的伤口并发症有关.
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