A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Postoperative Complications and Reoperative Surgery in the Treatment of Patients With Zenker Diverticulum
Tekijät: Uoti Sandra, Nurminen Nelli, Andersson Saana, Egan Caitlin, Tapiovaara Laura, Kytö Ville, Ilonen Ilkka
Kustantaja: AMER MEDICAL ASSOC
Julkaisuvuosi: 2023
Journal: JAMA Otolaryngology-Head and Neck Surgery
Tietokannassa oleva lehden nimi: JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY
Lehden akronyymi: JAMA OTOLARYNGOL
Vuosikerta: 149
Numero: 8
Aloitussivu: 690
Lopetussivu: 696
Sivujen määrä: 7
ISSN: 2168-6181
eISSN: 2168-619X
DOI: https://doi.org/10.1001/jamaoto.2023.1284
Verkko-osoite: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2805943
Importance
The association of the surgical approach, surgical specialty, and other factors with the outcomes of surgical treatment of Zenker diverticulum (ZD) have been debated in the literature.
Objectives
To explore the outcomes of 3 different surgical methods used in the management of ZD and determine the associations between patient characteristics, such as preoperative comorbidities and treatment outcomes.
Design, Setting, and Participants
This retrospective, population-based cohort study examined patient records of patients who underwent surgical treatment for ZD from the Care Register for Healthcare database in Finland between January 1996 and December 2015. Data review and analysis were completed in 2021.
Exposure
Surgical treatment for ZD.
Main Outcome and Measures
Complications of surgical procedures used in the management of ZD.
Results
In this study, 1044 patients (median [IQR] age, 70.0 [22.0-98.0] years; 416 female individuals [39.8%]) surgically treated for ZD were identified. Most patients (606 [58.0%]) had no preoperative comorbidities. A total of 67 (6.4%) complications were recorded, with a mortality rate of 0.9%. The likelihood of complications was associated with patient age (t [1042] = 2.28; Cohen d, 0.29; 95%, CI 0.04, 0.54), surgical approach (Cramer V = 0.14 [95% CI 0.07-0.21]), and surgical specialty (Cramer V, 0.16; 95% CI, 0.06-0.28). The median (IQR) length of stay in association with the primary surgical intervention was 3.0 (0-85.0) days. Length of stay was associated with patient age (Cramer V, 0.14; 95% CI, 0.06-0.25), especially in patients older than 90 years, surgical approach (F [2, 466.2] = 26.9; ηp2 = 0.08; 95% CI, 0.05-0.11), and surgical specialty (F [4, 22.1] = 11.0; ηp2 = 0.07; 95% CI, 0.04-0.10). Reoperation was associated with the initial surgical approach (Cramer V, 0.18; 95% CI, 0.12-0.23) and surgical specialty (Cramer V, 0.14; 95% CI, 0.09-0.21).
Conclusions and Relevance
The results of this cohort study suggest that the outcomes of surgical management depended on the surgical approach, surgical specialty, and patient age. Overall, surgical treatment may be considered safe and may be considered for all patients with symptomatic ZD
