| Abstract | Cilj: istražiti povezanost sniženih vrijednosti faznog kuta s pogoršanjem bolničkih ishoda učinkovitosti kod operiranih od kolorektalnog karcinoma.
Izvori podataka i metode: Ova retrospektivna studija provedena na Klinici za kirurgiju KBC Split obuhvatila je 422 pacijenta operirana zbog CRC od 1. ožujka 2021. do 29. veljače 2024. Podaci su prikupljeni iz elektroničkih baza i analizirani statistički. Primarni ishodi obuhvatili su duljinu boravka, stopu rehospitalizacija, mortalitet i troškove, dok su sekundarni obuhvatili komplikacije prema Clavien-Dindo klasifikaciji.
Rezultati: Medijan dobi pacijenata bio je 69 godina, a 37,4% pacijenata činile su žene. Najčešće izvedene operacije bile su desna hemikolektomija (157), lijeva hemikolektomija (41) i resekcija sigmoida, rektuma i rektosigmoida (185), dok je laparoskopski pristup primijenjen u 132 slučaja (uz 10,6% konverzije u otvoreni pristup). Većina pacijenata imala je T3 tumore (59%), a 40% je imalo bolest proširenu na regionalne limfne čvorove. Coxovom regresijskom analizom identificirani su četiri prediktora smrtnosti: dob, fazni kut bioelektrične impedancije, masa masnog tkiva i rizik od pada prema Morseovoj ljestvici. Povećanje faznog kuta za 1° smanjuje rizik od smrti 4,45 puta. Model rizika imao je AUC 0,837, sa senzitivnošću 100% i specifičnošću 66%. Preživljavanje u prvih 30 dana nakon operacije bilo je 100% za pacijente bez rizika, dok je za rizične pacijente bilo samo 36,6% (P = 0,006). Medijan poslijeoperacijskog boravka bio je 7 dana. Laparoskopske operacije skratile su boravak za jedan dan. Dulji boravak zabilježen je kod pacijenata s višim rizikom za dekubituse i komplikacije. Povećanje faznog kuta od 1,15° skratilo je boravak za jedan dan. Stopa ponovnog prijema unutar 30 dana bila je 11,6%, s višom stopom među muškarcima (75,5%). Najveća stopa ponovnog prijema bila je nakon amputacije rektuma (20,8%) za razliku od desne hemikolektomije (8%). Medijan troškova liječenja bio je 2697 EUR, a ekstremni troškovi (>5685 EUR) zabilježeni su u 4,3% slučajeva, povezani s duljinom boravka, komplikacijama i stopom ponovnog prijema. Najniži troškovi bili su za desnu hemikolektomiju (2107 EUR), dok su laparoskopske operacije resekcije rektosigmoida bile skuplje za 443 EUR
Rasprava i zaključci: Fazni kut bioelektrične impedancije je dokazano značajan prediktivan faktor za ključne ishode liječenja kao i druga BIA mjerenja (poput mase masnog tkiva). Međutim, diferencijacija utjecaja faznog kuta na bolničke ishode učinkovitosti dominantno ovisi o tipu operacija i operativnom pristupu. Potrebna su daljnja istraživanja u uravnoteženim kohortama kako bi se jasno prikazao mogući utjecaj i predikcija na ove ishode. |
| Abstract (english) | Objective: To investigate the association between reduced phase angle values and the deterioration of hospital outcomes in colorectal cancer (CRC) patients undergoing surgery.
Data sources and methods: This retrospective study was conducted at the Surgical Clinic of KBC Split, including 422 patients who underwent surgery for CRC between March 1, 2021, and February 29, 2024. Data were collected from electronic databases and analyzed statistically. Primary outcomes included length of stay, rehospitalization rates, mortality, and costs, while secondary outcomes involved complications according to the Clavien-Dindo classification.
Results: The median age of patients was 69 years, with 37.4% being women. The most common surgeries performed were right hemicolectomy (157), left hemicolectomy (41), and sigmoid, rectum, and rectosigmoid resections (185). Laparoscopic approach was used in 132 cases (with a 10.6% conversion rate to open surgery). Most patients had T3 tumors (59%), and 40% had disease spread to regional lymph nodes. Cox regression analysis identified four predictors of mortality: age, phase angle of bioelectrical impedance, fat mass, and fall risk according to the Morse scale. An increase in phase angle by 1° reduced the mortality risk by 4.45 times. The risk model had an AUC of 0.837, with 100% sensitivity and 66% specificity. Survival within the first 30 days after surgery was 100% for patients without risk, while it was only 36.6% for high-risk patients (P = 0.006). The median postoperative stay was 7 days. Laparoscopic surgery shortened the stay by one day. Longer stays were observed in patients with higher risk for decubitus ulcers and complications. An increase in phase angle by 1.15° reduced the length of stay by one day. The 30-day rehospitalization rate was 11.6%, with higher rates among men (75.5%). The highest rehospitalization rate was observed after rectal amputation (20.8%) compared to right hemicolectomy (8%). Laparoscopic approach reduced the need for rehospitalization, but the difference was not statistically significant (P = 0.055). Conversion from laparoscopic to open surgery was significantly more frequent in patients readmitted (21.1% vs 4.8%, P = 0.007). The median treatment cost was 2697 EUR, with extreme costs (>5685 EUR) recorded in 4.3% of cases, linked to length of stay, complications, and rehospitalization rates. The lowest costs were for right hemicolectomy (2107 EUR), while laparoscopic resections of the rectosigmoid were 443 EUR more expensive.
Discussion & Conclusions: The phase angle of bioelectrical impedance is a significant predictor of key treatment outcomes, as are other BIA measurements (e.g., fat mass). However, the differential impact of phase angle on hospital outcomes largely depends on the type of surgery and surgical approach. Further research in balanced cohorts is needed to clearly define the potential impact and predictive value on these outcomes. |
