Liu L L, Leung J M
Department of Anesthesia, University of California, San Francisco, USA.
J Am Geriatr Soc. 2000 Apr;48(4):405-12. doi: 10.1111/j.1532-5415.2000.tb04698.x.
The identification of reversible factors that are associated with postoperative morbidity in geriatric surgical patients is critical to improving perioperative outcomes in such patients. Our study aimed to compare the relative importance of intraoperative versus preoperative factors in predicting adverse postoperative outcomes in geriatric patients.
Retrospective cohort study of consecutive patients undergoing noncardiac surgery in 1995.
Two University of California, San Francisco, teaching hospitals--Moffitt/Long and Mount Zion medical centers.
All men and women 80 years of age or older undergoing noncardiac surgery.
Medical records of all patients were reviewed to measure predefined pre- and intraoperative risk factors and postoperative outcomes. Predictors of postoperative outcomes were identified by multivariate logistic regression analyses.
Three hundred sixty-seven patients were studied. The most prevalent preoperative risk factors were a history of hypertension and coronary artery, pulmonary, and neurologic diseases. Postoperative in-hospital mortality rate was 4.6%, and 25% of patients developed adverse postoperative outcomes, of which neurological and cardiovascular complications were the leading causes of morbidity (15% and 12%, respectively). By multivariate logistic regression, a history of neurological disease (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.3 - 6.9, P = .0001), congestive heart failure (OR 2.7, 95% CI 1.4 - 5.3, P = .004), and a history of arrhythmia (OR 2.3, 95% CI 1.2 - 4.3, P = .01) increased the odds of adverse postoperative events. The only intraoperative event shown to be predictive of postoperative complications was the use of vasoactive agents (OR 8.0, 95% CI 1.6 - 40.5, P = .009).
In this group of geriatric surgical patients, the overall postoperative in-hospital mortality rate was 4.6%, and 25% of the patients developed adverse postoperative outcomes involving either the neurological, cardiovascular, or pulmonary systems. Intraoperative events appeared to be less important than preoperative comorbidities in predicting adverse postoperative outcomes.
识别与老年外科患者术后发病相关的可逆因素对于改善此类患者的围手术期结局至关重要。我们的研究旨在比较术中因素与术前因素在预测老年患者术后不良结局方面的相对重要性。
对1995年接受非心脏手术的连续患者进行回顾性队列研究。
加利福尼亚大学旧金山分校的两家教学医院——莫菲特/朗和锡安山医疗中心。
所有80岁及以上接受非心脏手术的男性和女性。
审查所有患者的病历，以测量预先定义的术前和术中危险因素以及术后结局。通过多因素逻辑回归分析确定术后结局的预测因素。
共研究了367例患者。最常见的术前危险因素是高血压病史以及冠状动脉、肺部和神经系统疾病史。术后住院死亡率为4.6%，25%的患者出现术后不良结局，其中神经系统和心血管并发症是发病的主要原因（分别为15%和12%）。通过多因素逻辑回归分析，神经系统疾病史（比值比[OR]4.0，95%置信区间[CI]2.3 - 6.9，P = 0.0001）、充血性心力衰竭（OR 2.7，95% CI 1.4 - 5.3，P = 0.004）和心律失常病史（OR 2.3，95% CI 1.2 - 4.3，P = 0.01）增加了术后不良事件的发生几率。唯一被证明可预测术后并发症的术中事件是使用血管活性药物（OR 8.0，95% CI 1.6 - 40.5，P = 0.009）。
在这组老年外科患者中，术后总体住院死亡率为4.6%，25%的患者出现涉及神经系统、心血管系统或肺部系统的术后不良结局。在预测术后不良结局方面，术中事件似乎不如术前合并症重要。
