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An NSQIP evaluation of practice patterns and outcomes following surgery for anorectal abscess and fistula in patients with and without Crohn’s disease

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Gastroenterology Report 2013年第1期1卷 58-63页

作者： Marlin Wayne Causey Daniel Nelson Eric K.Johnson Justin Maykel Brad Davis David E.Rivadeneira Brad Champagne Scott R.Steele Department of Surgery Madigan Army Medical SystemMadigan Health SystemTacomaWA 98431USA

Background:Patients with Crohn’s disease(CD)are believed to have more aggressive anorectal abscess and fistula *** assessed the types of procedures performed and perioperative complications associated with the surgical management of anorectal abscess and fistula disease in patients with and without ***:The American College of Surgeons National Surgical Quality Improvement Program database(ACS-NSQIP,2005-2010)was used to calculate 30-day outcomes using regression modeling,accounting for demographics,comorbidities and surgical ***-9 codes for anorectal abscess or fistula were used for initial *** were then stratified,based on the presence or absence of underlying *** procedures included incision and drainage of abscesses,fistulotomy and seton *** fistulas were considered simple,while all others were classified as complex(-vaginal,-urethral and-vesical).Results:A total of 7,218 patients(mean age 45 years;64%male)met inclusion criteria,with underlying CD in 345(4.8%).CD patients were more likely to have a seton placed(9.9 vs 8.2%,P<0.001)and be on steroids(15.4 vs 4.3%,P<0.001).Thirty-seven percent of CD patients underwent local procedures,while 46%had a proctectomy and8%underwent *** was more common in those without underlying CD(16 vs 11%,P<0.001).The overall complication rate after local treatment was 4.9%,with no difference between patients with and without CD(7.7 vs 4.9%,P=0.144).This was not affected by fistula type-simple(7.9 vs 3.9%,P=0.194)vs complex(33 vs 7.1%,P=0.21)—or when stratified by wound(3.8 vs 2.4%;P=0.26)or systemic complications(3.8 vs 2.5%;P=0.53).Yet,complications following emergency procedures were higher in patients with CD(21.4 vs 5.9%,P=0.047).Factors significantly associated with increased complications were Crohn’s disease(OR=8.2),lack of functional independence(OR=2.0),pre-operative weight loss(OR=2.6)and pre-operative acute renal failure(OR=5.6).Steroids were al

关键词： National Surgical Quality Improvement Program(NSQIP) Crohn’s disease anorectal diseases anorectal abscess fistula-in-ano

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Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

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World Journal of Gastrointestinal Surgery 2024年第11期16卷 3425-3436页

作者： Shan-Zhong Chen Kui-Jun Sun Yi-Fan Gu Hong-Yuan Zhao Dong Wang Yun-Fang Shi Ren-Jie Shi First Clinical Medical College The Affiliated Hospital of Nanjing University of Chinese MedicineNanjing 210029Jiangsu ProvinceChina Department of anorectal Surgery People's Hospital of YangzhongZhenjiang 212200Jiangsu ProvinceChina Department of Ultrasound Medicine People's Hospital of YangzhongZhenjiang 212200Jiangsu ProvinceChina Department of Medical Imaging People's Hospital of YangzhongZhenjiang 212200Jiangsu ProvinceChina Department of Colorectal Surgery Jiangsu Province Hospital of Chinese MedicineNanjing 210029Jiangsu ProvinceChina

BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal *** To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical *** In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was *** factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal *** year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,***χ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(Pabscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(Pabscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,Panorectal abscess recurrence using multivariatelogistic *** mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone ab

关键词： anorectal abscess New classification Clinical characteristics Risk factors Postoperative recurrence rate Surgical procedure

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