Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation

期刊论文
发表日期：

2024年10月25日

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Tetsuro Tominaga,
Takashi Nonaka,
Hiroshi Yano,
Shuntaro Sato,
Taiga Ichinomiya,
Motohiro Sekino,
Toshio Shiraishi,
Shintaro Hashimoto,
Keisuke Noda,
Rika Ono,
Makoto Hisanaga,
Mitsutoshi Ishii,
Shosaburo Oyama,
Kazuhide Ishimaru,
Tetsuya Hara,
Keitaro Matsumoto

摘要

Purpose

Postoperative management for colonic perforation is an important prognostic factor, but whether intensivists perform postoperative management varies between institutions.

Methods

We investigated 291 patients with colonic perforation between 2018 and 2022. Patients were divided into those managed by an intensivists (ICU group; n = 40) and those not managed by an intensivists (non-ICU group; n = 251). We examined how management by intensivists affected prognosis using inverse probability weighting, and clarified which patients should consult an intensivists.

Results

The ICU group showed a significantly higher shock index (1.15 vs. 0.75, p < 0.01), higher APACHE II score (16.0 vs. 10.0, p < 0.001), and more severe comorbidities (Charlson Comorbidity Index 5.0 vs. 1.0, p < 0.001) and general peritonitis (85% vs. 38%, p < 0.001). Adjusted risk differences were − 24% (-34% to -13%) for 6-month mortality rate. Six-month mortality was improved by ICU intensivist management in patients with general peritonitis (risk difference − 22.8; 95% confidence interval − 34 to -11); APACHE II score ≥20 (-0.79; -1.06 to -0.52); lactate ≥1.6 (-0.38; -0.57 to -0.29); shock index ≥1.0 (-40.01; -54.87 to -25.16); and catecholamine index ≥10 (-41.16; -58.13 to -24.19).

Conclusions

Intensivists were involved in treating patients in poor general condition, but prognosis was extremely good. Appropriate case consultation with intensivists is important.