Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation
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 man...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2024-10, Vol.409 (1), p.325, Article 325 |
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| creator | Tominaga, Tetsuro Nonaka, Takashi Yano, Hiroshi Sato, Shuntaro Ichinomiya, Taiga Sekino, Motohiro Shiraishi, Toshio Hashimoto, Shintaro Noda, Keisuke Ono, Rika Hisanaga, Makoto Ishii, Mitsutoshi Oyama, Shosaburo Ishimaru, Kazuhide Hara, Tetsuya Matsumoto, Keitaro |
| description | 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
|
| doi_str_mv | 10.1007/s00423-024-03516-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3120601383</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3120601383</sourcerecordid><originalsourceid>FETCH-LOGICAL-c228t-6be25b7856ee6da2f4aad720be81c72ca592e22013875d62f54e06651c7499a53</originalsourceid><addsrcrecordid>eNp9kEtPwzAQhC0EolD4AxyQj1wCfqc5ooqXVAkOcLYcd1OlauxgO0j99zi0VJw47Wpn5pN2ELqi5JYSUt5FQgTjBWGiIFxSVYgjdEYFlwUTkh7_2SfoPMY1IUSVlThFE14JyUUlz1D3FvzK-Zhai9uuNzZh3-A-H3wPwaT2C3BnnFlBBy7heouNw61L4OIoWRMAD65Nh1sbEzZNgoCt33iXsZnT-BHl3QU6acwmwuV-TtHH48P7_LlYvD69zO8XhWVslgpVA5N1OZMKQC0Na4Qxy5KRGmbUlswaWTFgjFA-K-VSsUYKIErJLIqqMpJP0c2O2wf_OUBMumujhc3GOPBD1JwyosY4z1a2s9rgYwzQ6D60nQlbTYkea9a7mnWuWf_UrEUOXe_5Q93B8hD57TUb-M4Qs-RWEPTaD8Hln__DfgM-booi</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3120601383</pqid></control><display><type>article</type><title>Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Tominaga, Tetsuro ; Nonaka, Takashi ; Yano, Hiroshi ; Sato, Shuntaro ; Ichinomiya, Taiga ; Sekino, Motohiro ; Shiraishi, Toshio ; Hashimoto, Shintaro ; Noda, Keisuke ; Ono, Rika ; Hisanaga, Makoto ; Ishii, Mitsutoshi ; Oyama, Shosaburo ; Ishimaru, Kazuhide ; Hara, Tetsuya ; Matsumoto, Keitaro</creator><creatorcontrib>Tominaga, Tetsuro ; Nonaka, Takashi ; Yano, Hiroshi ; Sato, Shuntaro ; Ichinomiya, Taiga ; Sekino, Motohiro ; Shiraishi, Toshio ; Hashimoto, Shintaro ; Noda, Keisuke ; Ono, Rika ; Hisanaga, Makoto ; Ishii, Mitsutoshi ; Oyama, Shosaburo ; Ishimaru, Kazuhide ; Hara, Tetsuya ; Matsumoto, Keitaro</creatorcontrib><description>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.</description><identifier>ISSN: 1435-2451</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-024-03516-4</identifier><identifier>PMID: 39453495</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Aged ; Aged, 80 and over ; APACHE ; Cardiac Surgery ; Colonic Diseases - mortality ; Colonic Diseases - surgery ; Critical Care ; Female ; General Surgery ; Humans ; Intensive Care Units ; Intestinal Perforation - mortality ; Intestinal Perforation - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Postoperative Care - methods ; Prognosis ; Retrospective Studies ; Thoracic Surgery ; Traumatic Surgery ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2024-10, Vol.409 (1), p.325, Article 325</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c228t-6be25b7856ee6da2f4aad720be81c72ca592e22013875d62f54e06651c7499a53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-024-03516-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-024-03516-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39453495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tominaga, Tetsuro</creatorcontrib><creatorcontrib>Nonaka, Takashi</creatorcontrib><creatorcontrib>Yano, Hiroshi</creatorcontrib><creatorcontrib>Sato, Shuntaro</creatorcontrib><creatorcontrib>Ichinomiya, Taiga</creatorcontrib><creatorcontrib>Sekino, Motohiro</creatorcontrib><creatorcontrib>Shiraishi, Toshio</creatorcontrib><creatorcontrib>Hashimoto, Shintaro</creatorcontrib><creatorcontrib>Noda, Keisuke</creatorcontrib><creatorcontrib>Ono, Rika</creatorcontrib><creatorcontrib>Hisanaga, Makoto</creatorcontrib><creatorcontrib>Ishii, Mitsutoshi</creatorcontrib><creatorcontrib>Oyama, Shosaburo</creatorcontrib><creatorcontrib>Ishimaru, Kazuhide</creatorcontrib><creatorcontrib>Hara, Tetsuya</creatorcontrib><creatorcontrib>Matsumoto, Keitaro</creatorcontrib><title>Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>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.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>APACHE</subject><subject>Cardiac Surgery</subject><subject>Colonic Diseases - mortality</subject><subject>Colonic Diseases - surgery</subject><subject>Critical Care</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Intestinal Perforation - mortality</subject><subject>Intestinal Perforation - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Postoperative Care - methods</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><issn>1435-2451</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtPwzAQhC0EolD4AxyQj1wCfqc5ooqXVAkOcLYcd1OlauxgO0j99zi0VJw47Wpn5pN2ELqi5JYSUt5FQgTjBWGiIFxSVYgjdEYFlwUTkh7_2SfoPMY1IUSVlThFE14JyUUlz1D3FvzK-Zhai9uuNzZh3-A-H3wPwaT2C3BnnFlBBy7heouNw61L4OIoWRMAD65Nh1sbEzZNgoCt33iXsZnT-BHl3QU6acwmwuV-TtHH48P7_LlYvD69zO8XhWVslgpVA5N1OZMKQC0Na4Qxy5KRGmbUlswaWTFgjFA-K-VSsUYKIErJLIqqMpJP0c2O2wf_OUBMumujhc3GOPBD1JwyosY4z1a2s9rgYwzQ6D60nQlbTYkea9a7mnWuWf_UrEUOXe_5Q93B8hD57TUb-M4Qs-RWEPTaD8Hln__DfgM-booi</recordid><startdate>20241025</startdate><enddate>20241025</enddate><creator>Tominaga, Tetsuro</creator><creator>Nonaka, Takashi</creator><creator>Yano, Hiroshi</creator><creator>Sato, Shuntaro</creator><creator>Ichinomiya, Taiga</creator><creator>Sekino, Motohiro</creator><creator>Shiraishi, Toshio</creator><creator>Hashimoto, Shintaro</creator><creator>Noda, Keisuke</creator><creator>Ono, Rika</creator><creator>Hisanaga, Makoto</creator><creator>Ishii, Mitsutoshi</creator><creator>Oyama, Shosaburo</creator><creator>Ishimaru, Kazuhide</creator><creator>Hara, Tetsuya</creator><creator>Matsumoto, Keitaro</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20241025</creationdate><title>Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation</title><author>Tominaga, Tetsuro ; Nonaka, Takashi ; Yano, Hiroshi ; Sato, Shuntaro ; Ichinomiya, Taiga ; Sekino, Motohiro ; Shiraishi, Toshio ; Hashimoto, Shintaro ; Noda, Keisuke ; Ono, Rika ; Hisanaga, Makoto ; Ishii, Mitsutoshi ; Oyama, Shosaburo ; Ishimaru, Kazuhide ; Hara, Tetsuya ; Matsumoto, Keitaro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c228t-6be25b7856ee6da2f4aad720be81c72ca592e22013875d62f54e06651c7499a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>APACHE</topic><topic>Cardiac Surgery</topic><topic>Colonic Diseases - mortality</topic><topic>Colonic Diseases - surgery</topic><topic>Critical Care</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Intestinal Perforation - mortality</topic><topic>Intestinal Perforation - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Postoperative Care - methods</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tominaga, Tetsuro</creatorcontrib><creatorcontrib>Nonaka, Takashi</creatorcontrib><creatorcontrib>Yano, Hiroshi</creatorcontrib><creatorcontrib>Sato, Shuntaro</creatorcontrib><creatorcontrib>Ichinomiya, Taiga</creatorcontrib><creatorcontrib>Sekino, Motohiro</creatorcontrib><creatorcontrib>Shiraishi, Toshio</creatorcontrib><creatorcontrib>Hashimoto, Shintaro</creatorcontrib><creatorcontrib>Noda, Keisuke</creatorcontrib><creatorcontrib>Ono, Rika</creatorcontrib><creatorcontrib>Hisanaga, Makoto</creatorcontrib><creatorcontrib>Ishii, Mitsutoshi</creatorcontrib><creatorcontrib>Oyama, Shosaburo</creatorcontrib><creatorcontrib>Ishimaru, Kazuhide</creatorcontrib><creatorcontrib>Hara, Tetsuya</creatorcontrib><creatorcontrib>Matsumoto, Keitaro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tominaga, Tetsuro</au><au>Nonaka, Takashi</au><au>Yano, Hiroshi</au><au>Sato, Shuntaro</au><au>Ichinomiya, Taiga</au><au>Sekino, Motohiro</au><au>Shiraishi, Toshio</au><au>Hashimoto, Shintaro</au><au>Noda, Keisuke</au><au>Ono, Rika</au><au>Hisanaga, Makoto</au><au>Ishii, Mitsutoshi</au><au>Oyama, Shosaburo</au><au>Ishimaru, Kazuhide</au><au>Hara, Tetsuya</au><au>Matsumoto, Keitaro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2024-10-25</date><risdate>2024</risdate><volume>409</volume><issue>1</issue><spage>325</spage><pages>325-</pages><artnum>325</artnum><issn>1435-2451</issn><eissn>1435-2451</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39453495</pmid><doi>10.1007/s00423-024-03516-4</doi></addata></record> |
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| subjects | Abdominal Surgery Aged Aged, 80 and over APACHE Cardiac Surgery Colonic Diseases - mortality Colonic Diseases - surgery Critical Care Female General Surgery Humans Intensive Care Units Intestinal Perforation - mortality Intestinal Perforation - surgery Male Medicine Medicine & Public Health Middle Aged Postoperative Care - methods Prognosis Retrospective Studies Thoracic Surgery Traumatic Surgery Vascular Surgery |
| title | Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation |
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