Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study

被引:1
|
作者
von Savigny, Clara [1 ]
Juratli, Mazen A. A. [2 ]
Koch, Christine [3 ]
Gruber-Rouh, Tatjana [4 ]
Bechstein, Wolf O. O. [1 ]
Schreckenbach, Teresa [1 ]
机构
[1] Goethe Univ Frankfurt Main, Frankfurt Univ Hosp & Clin, Dept Gen Visceral Transplantat & Thorac Surg, Theodor Stern Kai 7, D-60596 Frankfurt, Germany
[2] Muenster Univ Hosp, Dept Gen Visceral & Transplant Surg, Munster, Germany
[3] Goethe Univ Frankfurt Main, Frankfurt Univ Hosp & Clin, Dept Internal Med, Theodor Stern Kai 7, D-60596 Frankfurt, Germany
[4] Goethe Univ Frankfurt Main, Frankfurt Univ Hosp & Clin, Inst Diagnost & Intervent Radiol, Theodor Stern Kai 7, D-60596 Frankfurt, Germany
关键词
Resident involvement; Surgical trainee; Education; Diverting loop ileostomy; Patient care; PROLONGED OPERATIVE DURATION; SURGICAL SITE INFECTION; SKIN CLOSURE; HAND SUTURE; COMPLICATIONS; MORBIDITY; RISK; METAANALYSIS; EXPERIENCE; SURGERY;
D O I
10.1007/s00384-023-04390-0
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aim The reversal of diverting loop ileostomy (DLI) is one of surgical trainees' first procedures. Complications of DLI reversal can cause life-threatening complications and increase patient morbidity. This study compared DLI reversals performed by surgical trainees with those by attending surgeons. Method This retrospective cohort study was performed at a single primary care center on 300 patients undergoing DLI reversal. The primary outcome was morbidity, according to the Clavien-Dindo classification (CDC), with special attention paid to the surgeon's level of training. The secondary endpoint was postoperative intestinal motility dysfunction. Results Surgical trainees had significantly longer operation times (p < 0.001) than attending surgeons. Univariate analyses revealed no influence on the level of training for postoperative morbidity. First bowel movement later than 3 days after surgery was a significant risk factor for CDC = 3 (OR, 4.348; 96% CI, 1670-11.321; p = 0.003). Independent risk factors for surgical site infections (SSIs) were an elevated BMI (OR, 1.162; 95% CI, 1.043-1.1294; p = 0.007) and a delayed bowel movement (OR, 3.973; 95% CI, 1.300- 12.138; p = 0.015). For postoperative intestinal motility dysfunction, an independent risk factor was a primary malignant disease (OR, 1.980; 95% CI, 1.120- 3.500; p = 0.019), and side-to-side stapled anastomosis was a protective factor (OR, 0.337; 95% CI 0.155-0.733; p = 0.006). Conclusion Even though surgical trainees needed significantly more time to perform the surgery, the level of surgical training was not a risk factor for increased postoperative morbidity. Instead, delayed first bowel movement was predictive of SSI.
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页数:8
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