大概尿道手术中的泌尿损伤：全国队列的结果和危险因素
Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort
影响因子:2.90000
分区:医学3区 / 胃肠肝病学3区 外科3区
发表日期:2024 Oct 03
作者:
P H McClelland, T Liu, R P Johnson, C Glenn, G Ozuner
摘要
医源性泌尿损伤（IUI）会在结直肠手术后导致明显的并发症，尤其是在诊断延迟时。这项研究分析了与IUI相关的危险因素，并在接受结直肠手术的患者中延迟IUI。多变量回归分析用于确定与IUI相关的危险因素和结果，并延迟IUI.Among 566,036例患者，5836例患者（1.0％）在结直肠手术后患有IUI，其中236例（4.0％）（4.0％）延迟了IUI。鉴定出IUI和延迟IUI的多个术前危险因素，并具有散布的癌症[调整后的优势比（AOR）1.4，95％置信区间（CI）1.2-1.5; p <0.001]和憩室疾病[AOR 1.1，95％CI 1.0-1.2; p = 0.009]与IUI相关，体重指数增加[AOR 1.6，95％CI 1.2-2.1; P = 0.003]和腹水[AOR 5.6，95％CI 2.1-15.4; p = 0.001]与延迟IUI相关。腹腔镜方法与IUI风险降低有关[AOR 0.4，95％CI 0.4-0.5; p <0.001]并增加了延迟IUI的风险[AOR 1.8，95％CI 1.4-2.5; p <0.001]。 IUI和延迟的IUI都与术后发病率显着相关，并且在延迟IUI中看到严重的多机器人并发症。尽管IUI很少发生在结直肠手术中，但未识别的伤害可能会使修复变得复杂并引起其他负面的术后爆发。患有复杂腹腔内病理学的患者的IUI风险增加，并且接受腹腔镜手术的大身体习惯的患者延迟IUI的风险增加。
Abstract
Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures.Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI.Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI.While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.