Stent as a bridge to surgery or immediate colectomy for malignant right colonic obstruction: propensity-scored, national database study

Abstract

Background The aim of this study was to compare perioperative outcomes of urgent colectomy and placement of a self‐expanding metallic stent followed by colectomy for patients with malignant right colonic obstruction. Right‐sided malignant obstruction is less common than left‐sided. Stenting for malignant left colonic obstruction has been reported to reduce postoperative complications. However, the impact of stenting for malignant right colonic obstruction remains undefined. Methods The study included patients with right‐sided malignant obstruction or stenosis undergoing colectomy between April 2012 and March 2017 identified from a nationwide database. Propensity score matching analysis was used to compare mortality and morbidity rates, proportion receiving a stoma and postoperative stay between urgent colectomy and stent groups. Results From 9572 patients, 1500 pairs were generated by propensity score matching. There was no significant difference in in‐hospital mortality between the urgent colostomy and stent groups (1·6 versus 0·9 per cent respectively; P = 0·069). Complications were more common after urgent colectomy than stenting (22·1 versus 19·1 per cent; P = 0·042). Surgical‐site infection was more likely with urgent colectomy (7·1 versus 4·4 per cent; P = 0·001). There was no significant difference between the two groups in anastomotic leakage (3·8 versus 2·6 per cent; P = 0·062). The proportion of patients needing a stoma was higher with urgent colectomy than primary treatment with stents (5·1 versus 1·7 per cent; P < 0·001). Postoperative stay was longer after urgent colectomy (15 versus 13 days; P < 0·001). Conclusion Stenting followed by colectomy in patients with malignant right colonic obstruction may provide more favourable perioperative outcomes than urgent colectomy.

Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma

“…Multivariate Cox proportional hazards model was used to analyze the risk factors related with the prognosis. Then, these covariates were matched by PSM with the allowable error at 0.3 (7)(8)(9) to compare the differences between the patients with RHCC and NHCC. The ratio of RHCC and NHCC patients was 1:4 in the PSM analysis.…”

Patient backgrounds and short‐term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis

“…The multivariate analysis showed that smoking is an independent risk factor for CA, and the smoking rate of CA patients was ~4% higher than that of UA patients in the present study, as in previous reports. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 A study of twins found that smoking is a risk factor for appendicitis, especially in women. 18 …”

“… 10 It contains discharge abstracts and administrative reimbursement claim data from inpatient cases collected at participating hospitals, and it has been used in various studies. 11 , 12 Details of this database have been reported by Yamana et al 13 The database includes the following data: disease names, hospitalization costs, urgent or planned hospital admission, comorbidities at admission and during hospitalization, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD‐10), age, sex, length of hospital stay (LOS), medical procedures including surgery, names and quantities of medicines administered, and discharge status (including in‐hospital deaths). Medical procedures are indexed with a Japanese code (K‐code, Table S1 ), 14 assigned by the Ministry of Health, Labor, and Welfare of Japan.…”

Validity of a model using routinely collected data for identifying infections following gastric, colon, and liver cancer surgeries

“…Using the claims data for procedures performed during postoperation hospitalization, we also created 17 candidate procedure variables that could indicate postoperative infections. Variable selection was based on previous studies using the DPC database 18–21 and clinical relevance (e.g., addition of intravenous antibiotics and drainage duration). Candidate procedure variables are presented in Table 1.…”

“…The features of the DPC data include subcategorized secondary diagnoses and detailed daily procedure records 17 . Numerous studies on therapeutics for patients who underwent surgery have been conducted using the DPC Study Group database 18–21 . A previous study assessed the validity of diagnosis and procedure records in the DPC data 22 ; however, the study targeted the diagnoses present on admission.…”