结直肠手术并发症3大危险因素：时间、BMI、术者

一项纳入3,000余例患者的单中心、前瞻性研究显示，手术室停留时间、体重指数和实施手术的外科医生，是影响结直肠手术后再次住院、输血和手术部位感染发生率的最重要的3个因素。

克利夫兰医院的Elena Manilich博士在美国结直肠外科医师协会(ASCRS)年会上指出，既往多项研究涉及危险因素和手术预后，但“关于各种危险因素对特定预后的相对作用却所知甚少”。Manilich博士及其同事分析了3,552例接受结直肠手术患者的预后。患者接受手术时的平均年龄为51岁，其中约半数为女性。癌症是最常见的手术指征(16%)。

结果显示，总体而言，手术时间长与并发症发生率增高显著相关。尤其是与不到200分钟的手术相比，接受持续超过200分钟手术者的输血、手术部位感染和脓肿以及伤口感染的校正比值比(OR)分别为2.79、2.11和2.09。外科医生手术经验不足20次也是患者发生手术部位感染、脓肿、再次手术和吻合口瘘的有意义预测因子。患者体重指数增加与伤口感染、手术部位感染以及门静脉和深静脉血栓独立相关。此外，患者年龄超过75岁与输血和再次手术独立相关。受并发症影响程度最大的预后为再次住院、输血、手术部位感染、伤口感染和脓肿。并发症的定义为出院前或手术后30天内的结局。

研究者总结认为，手术持续时间、实施手术者的经验、体重指数及年龄超过75岁，是结直肠手术后发生并发症的重要危险因素。

Manilich博士披露无相关利益冲突。

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Operating room time, body mass index, and the surgeon performing the procedure were the top three factors affecting readmission rates, transfusion rates, and surgical site infections after colorectal surgery in a single-center prospective study of more than 3,000 patients.

Many previous studies have addressed risk factors and surgical outcomes, but "little is known about the relative contribution of various risk factors to specific outcomes," said Elena Manilich, Ph.D., of the Cleveland Clinic. She presented the findings at the annual meeting of the American Society of Colon and Rectal Surgeons.

She and her colleagues analyzed outcomes from 3,552 patients who underwent colorectal surgery. Their average age at the time of surgery was 51 years, and approximately half were women. Cancer was the most common indication for surgery (16%).

Overall, the length of surgery was significantly associated with increased complication rates, Dr. Manilich said. In particular, the adjusted odds ratios for procedures lasting more than 200 minutes vs. those lasting less than 200 minutes were 2.79 for transfusion, 2.11 for surgical site infection and abscess, and 2.09 for wound infection.

Surgeons who performed fewer than 20 procedures were significant predictors of surgical site infections, abscesses, reoperation, and anastomotic leaks in their patients, Dr. Manilich said.

Increased patient body mass index was independently associated with wound infection, surgical site infection, and portal and deep vein thrombosis, she added.

In addition, a patient age older than 75 years was independently associated with transfusion and reoperation.

The outcomes that were most influenced by complications were hospital readmission, transfusion, surgical site infection, wound infections, and abscesses. Complications were defined as outcomes that occurred prior to hospital discharge or within 30 days of the initial surgery.

The findings were limited by the use of data from a single hospital and by the inability to adjust for patient histories (such as prior abdominal procedures) that might have affected the outcomes, Dr. Manilich said. But the study is unique in its use of a logistic regression analysis to identify which variables predict which outcomes, she added.

"An understanding of these results may be useful to colorectal surgeons who are making an effort to understand and improve their surgical outcomes," she said.

Dr. Manilich had no financial conflicts to disclose.