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复原性直肠结肠切除术后与败血症并发症相关的因素

Factors Associated With Septic Complications After Restorative Proctocolectomy
Kiran RP, da Luz Moreira A, Remzi FH   |    2010/7/9 14:05:06   | 
Ann Surg  |   2010   |          View at Publisher
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Objective:
Few studies have evaluated factors that may be associated with the development of septic complications after restorative proctocolectomy. Therefore, the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative proctocolectomy.

Methods:
Patients developing abdominal and pelvic septic complications after restorative proctocolectomy were identified from a prospective database. Patients with subclinical leaks and ileostomy closure leak were not included in the septic complication group. A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P<0.05.

Results:
From 1983 to 2007, 3233 patients (56% male) were included in the database. Eight-four percent (2597) of patients underwent proximal diversion. Two hundred patients (6.2%) developed septic complications within 3 months of restorative proctocolectomy or within 3 months of ileostomy closure. On multivariate analysis, body mass index>30 (P=0.02, OR=1.77), final pathologic diagnosis of ulcerative/indeterminate colitis (P=0.02, OR=2) or Crohn's disease (P=0.02, OR=3.6), intraoperative (P=0.02, OR=1.6), and postoperative transfusions (P=0.01, OR=1.9) were all independently associated with septic complications. We also demonstrated an independent association among individual surgeons (P=0.04) with decreased septic complications.

Conclusions:
Body mass index greater than 30, final pathologic diagnosis of ulcerative/indeterminate colitis or Crohn's disease, intraoperative and postoperative transfusions, and surgeon were all independent factors associated with septic complications after restorative proctocolectomy.
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