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J Gastrointest Surg ; 28(6): 843-851, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38522642

RESUMO

BACKGROUND: Patients with liver disease undergoing colectomy have higher rates of complications and mortality. The Albumin-Bilirubin score is a recently developed system, established to predict outcomes after hepatectomy, that accounts for liver dysfunction. METHODS: All patients undergoing colectomy were identified in the 2015-2018 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database. Demographics and outcomes were compared between patients with Albumin-Bilirubin Grade 1 vs. 2/3. Multivariable regression was performed for outcomes including colorectal-specific complications. Areas under the receiver operative characteristic curves were calculated to determine accuracy of the Albumin-Bilirubin score. RESULTS: Of 86,273 patients identified, 48% (N = 41,624) were Albumin-Bilirubin Grade 1, 45% (N = 38,370) Grade 2 and 7% (N = 6,279) Grade 3. Patents with Grade 2/3 compared to Grade 1 had significantly increased mortality (7.2% vs. 0.9%, p < 0.001) and serious morbidity (31% vs. 12%, p < 0.001). Colorectal-specific complications including anastomotic leak (3.7% vs. 2.8%, p < 0.001) and prolonged ileus (26% vs. 14%, p < 0.001) were higher in patients with Grade 2/3. Grade 2/3 had increased risk of mortality (odds ratio 3.07, p < 0.001) and serious morbidity (1.78, p < 0.001). Albumin-Bilirubin had excellent accuracy in predicting mortality (area under the curve 0.81, p < 0.001) and serious morbidity (0.70, p < 0.001). CONCLUSION: Albumin-Bilirubin is easily calculated using only serum albumin and total bilirubin values. Grade 2/3 is associated with increased rates of mortality and morbidity following colectomy. Albumin-Bilirubin can be applied to risk-stratify patients prior to colectomy.


Assuntos
Bilirrubina , Colectomia , Hepatopatias , Complicações Pós-Operatórias , Albumina Sérica , Humanos , Colectomia/métodos , Colectomia/efeitos adversos , Masculino , Feminino , Bilirrubina/sangue , Pessoa de Meia-Idade , Idoso , Albumina Sérica/análise , Albumina Sérica/metabolismo , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Hepatopatias/cirurgia , Hepatopatias/sangue , Hepatopatias/mortalidade , Estudos Retrospectivos , Curva ROC , Fístula Anastomótica/sangue , Fístula Anastomótica/etiologia , Fístula Anastomótica/epidemiologia , Íleus/etiologia , Íleus/sangue , Valor Preditivo dos Testes , Resultado do Tratamento
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