【medical-news】食管切除术后吻合口瘘的预测因素：一项针对胸外科医生协会数据库的分析
xxll2006 +2 丁当这个帖子发布于 11 年零 204 天前，其中的信息可能已发生改变或有所发展。
Predictorsof Anastomotic Leak After Esophagectomy: An Analysis of The Society of ThoracicSurgeons General Thoracic DatabaseKassis ES, Kosinski AS, Ross P Jr, Koppes KE, Donahue JM, Daniel VC.
Division of Thoracic Surgery,The Ohio StateUniversity MedicalCenter, Columbus, Ohio.Electronic address: edmund.kassis@osumc.edu.
Abstract
BACKGROUND:
Anastomotic leak is animportant cause of morbidity and mortality after esophagectomy. Few studieshave targeted risk factors for the development of leak after esophagectomy. Thepurpose of this study is to use The Society of Thoracic Surgeons Database toidentify variables associated with leak after esophagectomy.
METHODS:
The Society ofThoracic Surgeons Database was queried for patients treated with esophagectomyfor esophageal cancer between 2001 and 2011. Univariate and multivariateanalysis of variables associated with an increased risk anastomotic leak was performed.
RESULTS:
There were 7,595esophagectomies, with 804 (10.6%) leaks. Thirty-day mortality and length ofstay were higher for patients withanastomotic leak. Mortality in patientsrequiring surgical management was 11.6% (38 of 327) compared with 4.4% (20 of458) in medically managed leaks (p < 0.001). The leak rate washigher in patients with cervical anastomosis compared with those withintrathoracic anastomoses, 12.3% versus 9.3%, respectively (p = 0.006).There was no difference in leak-associated mortality between the twoapproaches. Factors associated with leak on univariate analysis includeobesity, heart failure, coronary disease, vascular disease, hypertension,steroids, diabetes, renal insufficiency, tobacco use, procedure durationgreater than 5 hours, and type of procedure (p < 0.05). Multivariableregression analysis associated heart failure, hypertension, renalinsufficiency, and type of procedure as risk factors for the development of leak (p< 0.05).
CONCLUSIONS:
Anastomotic leak afteresophagectomy is an important cause of postoperative mortality and increasedlength of stay. We have identi?ed important risk factors for the development ofesophageal anastomotic leak after esophagectomy. Further studies aimed at riskreduction are warranted.
Division of Thoracic Surgery,The Ohio StateUniversity MedicalCenter, Columbus, Ohio.Electronic address: edmund.kassis@osumc.edu.
Abstract
BACKGROUND:
Anastomotic leak is animportant cause of morbidity and mortality after esophagectomy. Few studieshave targeted risk factors for the development of leak after esophagectomy. Thepurpose of this study is to use The Society of Thoracic Surgeons Database toidentify variables associated with leak after esophagectomy.
METHODS:
The Society ofThoracic Surgeons Database was queried for patients treated with esophagectomyfor esophageal cancer between 2001 and 2011. Univariate and multivariateanalysis of variables associated with an increased risk anastomotic leak was performed.
RESULTS:
There were 7,595esophagectomies, with 804 (10.6%) leaks. Thirty-day mortality and length ofstay were higher for patients withanastomotic leak. Mortality in patientsrequiring surgical management was 11.6% (38 of 327) compared with 4.4% (20 of458) in medically managed leaks (p < 0.001). The leak rate washigher in patients with cervical anastomosis compared with those withintrathoracic anastomoses, 12.3% versus 9.3%, respectively (p = 0.006).There was no difference in leak-associated mortality between the twoapproaches. Factors associated with leak on univariate analysis includeobesity, heart failure, coronary disease, vascular disease, hypertension,steroids, diabetes, renal insufficiency, tobacco use, procedure durationgreater than 5 hours, and type of procedure (p < 0.05). Multivariableregression analysis associated heart failure, hypertension, renalinsufficiency, and type of procedure as risk factors for the development of leak (p< 0.05).
CONCLUSIONS:
Anastomotic leak afteresophagectomy is an important cause of postoperative mortality and increasedlength of stay. We have identi?ed important risk factors for the development ofesophageal anastomotic leak after esophagectomy. Further studies aimed at riskreduction are warranted.
