Background

The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes.

Methods

Our integrated health care system’s EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care.

Results

Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p < 0.001) with similar BMI (29.7 ± 9.0 kg/m² vs. 28.8 ± 8.3, p < 0.001). Patients in the laparoscopic group had lower mean CCI score (1.6 ± 2.3 vs. 3.4 ± 3.2, p ≤ 0.0001). On multivariable analysis, open surgery had the highest association with inpatient mortality (OR 8.67, 4.23–17.75, p < 0.0001) and at all time points (30-, 90-day, 1-, 3-year). At all time points, conversion to open was found to be a statistically significant protective factor.

Conclusion

Use of laparoscopy in EGS is common and associated with a decreased risk of all-cause mortality at all time points compared to open procedures. Conversion to open was protective at all time points compared to open procedures.

中文翻译：

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腹腔镜检查与区域卫生系统中接受紧急普通外科手术的患者的全因死亡率降低有关

背景

本研究的目的是评估腹腔镜手术在综合急症护理手术 (ACS) 网络中对普通急诊普外科 (EGS) 手术的应用。我们假设腹腔镜检查与改善结果相关。

方法

我们在 2013 年 1 月至 2015 年 10 月期间查询了根据 AAST EGS ICD-9 代码创建的综合医疗保健系统的 EGS 注册表。程序分为腹腔镜手术或开放手术。进行了标准描述性和单变量检验，并进行了控制开放状态、年龄、BMI、查尔森合并症指数 (CCI)、创伤等级和复苏诊断的多变量逻辑回归。使用跨护理事件的并发程序计费代码识别和分析转换为开放的腹腔镜程序。

结果

在 33 个月期间确定的 60,604 名 EGS 患者中，7280 名 (12.0%) 进行了手术，6914 名 (11.4%) 包括 AAST 定义的 EGS 程序。有 4813 例 (69.6%) 手术是通过腹腔镜进行的。接受腹腔镜手术的患者往往更年轻（45.7 ± 18.0 岁对 57.2 ± 17.6，p  < 0.001），BMI 相似（29.7 ± 9.0 kg/m ²对 28.8 ± 8.3，p  < 0.001）。腹腔镜组患者的平均 CCI 评分较低（1.6 ± 2.3 对 3.4 ± 3.2，p  ≤ 0.0001）。在多变量分析中，开放手术与住院死亡率的相关性最高 (OR 8.67, 4.23–17.75, p < 0.0001) 和所有时间点（30 天、90 天、1 年、3 年）。在所有时间点，转换为开放被发现是一个具有统计学意义的保护因素。

结论

在 EGS 中使用腹腔镜检查很常见，并且与开放手术相比，在所有时间点都可以降低全因死亡率的风险。与开放手术相比，转为开放手术在所有时间点都具有保护作用。