Tripp Henry F, Obney James A, Febinger Dennis L, Lisagor Philip G, Cohen David J
Department of Cardiothoracic Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Mil Med. 2002 Feb;167(2):109-12.
Emphasis on cost reduction, national standardization of medical care, and quality improvement initiatives have led to reduced postoperative hospital stays after cardiac surgery. The present study was designed to verify the observation that valve patients have longer lengths of stay than bypass patients and to identify possible reasons.
The inpatient records of 26 consecutive patients who underwent valve procedures at our institution were reviewed and compared with the records of 25 consecutive coronary bypass patients. Patients whose postoperative stays were longer than 2 weeks were considered outliers and were excluded from further review.
A total of 51 records were reviewed. There were no in-hospital deaths. Five patients in the valve group and two in the bypass group were excluded because of lengths of stay exceeding 14 days. The mean length of stay for the valve procedure group was 7.7 +/- 2.1 days, vs. 5.7 +/- 1.5 days for the coronary bypass group (p = 0.001). There were no reoperative procedures in either group, and the number of emergency procedures was higher in the bypass group. Both groups were similar with respect to age and sex. The frequencies of associated pulmonary disease and malnutrition were similar. Bypass patients had a higher incidence of vascular disease and/or renal disease. Sixty percent of valve procedures were complex operations. Valve patients had a higher incidence of cardiopulmonary bypass times exceeding 3 hours and more postoperative bleeding complications. Although not statistically significant, valve procedure patients were more likely to require prolonged mechanical ventilatory and circulatory support postoperatively. The frequencies of thrombotic complications, neurological complications, and nosocomial infections were similar for both groups. Postoperatively, more valve patients had atrial fibrillation, and all of them received anticoagulation. Multivariate analysis revealed only two factors to be significant with regard to length of stay: valvular surgery and the duration of postoperative ventilatory support.
Cardiac valve procedures are associated with prolonged lengths of stay compared with isolated coronary bypass procedures. Despite recent trends toward earlier operation, valve patients tended to present with advanced disease. More than half of the valve patients required complex surgical procedures. This is reflected in longer bypass times, increased bleeding complications, and more postoperative support. The proportion of valvular surgery patients should be considered when analyzing lengths of stay for cardiac surgery cohorts.
对降低成本、医疗服务国家标准以及质量改进措施的重视，已使心脏手术后的住院时间缩短。本研究旨在验证瓣膜手术患者比搭桥手术患者住院时间更长这一观察结果，并找出可能的原因。
回顾了我院连续26例行瓣膜手术患者的住院记录，并与连续25例行冠状动脉搭桥手术患者的记录进行比较。术后住院时间超过2周的患者被视为异常值并排除在进一步分析之外。
共回顾了51份记录。无院内死亡病例。瓣膜组有5例患者、搭桥组有2例患者因住院时间超过14天被排除。瓣膜手术组的平均住院时间为7.7±2.1天，冠状动脉搭桥组为5.7±1.5天（p = 0.001）。两组均无再次手术病例，搭桥组急诊手术例数更多。两组在年龄和性别方面相似。相关肺部疾病和营养不良的发生率相似。搭桥患者血管疾病和/或肾脏疾病的发生率更高。60%的瓣膜手术为复杂手术。瓣膜手术患者体外循环时间超过3小时以及术后出血并发症的发生率更高。虽然无统计学意义，但瓣膜手术患者术后更有可能需要长时间的机械通气和循环支持。两组血栓形成并发症、神经并发症和医院感染的发生率相似。术后，更多瓣膜手术患者发生房颤，且均接受了抗凝治疗。多因素分析显示，仅瓣膜手术和术后通气支持时间这两个因素与住院时间显著相关。
与单纯冠状动脉搭桥手术相比，心脏瓣膜手术的住院时间更长。尽管近期有早期手术的趋势，但瓣膜手术患者往往病情较重。超过半数的瓣膜手术患者需要进行复杂的外科手术。这表现为体外循环时间更长、出血并发症增加以及术后支持更多。在分析心脏手术队列的住院时间时，应考虑瓣膜手术患者的比例。
