Fleischmann Kirsten E, Goldman Lee, Young Belinda, Lee Thomas H
Department of Medicine, University of California, San Francisco 94143-0124, USA.
Am J Med. 2003 Nov;115(7):515-20. doi: 10.1016/s0002-9343(03)00474-1.
To determine the relation between cardiac and noncardiac complications and their effects on length of stay in patients undergoing noncardiac surgery.
We collected detailed information from the history, physical examination, and preoperative tests of 3970 patients aged > or =50 years who were undergoing major noncardiac procedures. Serial electrocardiograms and cardiac enzyme measurements were performed perioperatively, and cardiac and noncardiac complications were recorded prospectively. Multivariate logistic regression analysis was used to determine the association between cardiac and noncardiac complications, and linear regression was used to assess their effects on length of stay.
Cardiac complications occurred in 84 patients (2%), and noncardiac complications developed in 510 patients (13%). Both types of complications occurred in 40 patients (1%). The most common cardiac complications were pulmonary edema (n = 42) and myocardial infarction (n = 41). The most common noncardiac complications were wound infection (n = 291), confusion (n = 87), respiratory failure requiring intubation (n = 62), deep venous thrombosis (n = 48), and bacterial pneumonia (n = 46). Patients with cardiac complications were more likely to suffer a noncardiac complication than were those without cardiac complications, even after adjustment for preoperative clinical factors (odds ratio = 6.4; 95% confidence interval [CI]: 3.9 to 10.6). Mean length of stay was markedly increased in patients who experienced cardiac (11 days; 95% CI: 9 to 12 days) or noncardiac (11 days; 95% CI: 10 to 12 days) complications, or both (15 days; 95% CI: 12 to 18 days), as compared with patients without complications (4 days; 95% CI: 3 to 4 days), even after adjustment for procedure type and clinical factors.
Cardiac and noncardiac complications were strongly linked in patients undergoing noncardiac surgery. Patients who experienced one type of complication were at increased risk of developing the other type of complication as well as prolonged perioperative length of stay.
确定非心脏手术患者心脏并发症和非心脏并发症之间的关系及其对住院时间的影响。
我们收集了3970例年龄≥50岁接受大型非心脏手术患者的病史、体格检查和术前检查的详细信息。围手术期进行系列心电图和心肌酶测量，并前瞻性记录心脏和非心脏并发症。采用多变量逻辑回归分析确定心脏并发症和非心脏并发症之间的关联，并采用线性回归评估它们对住院时间的影响。
84例患者（2%）发生心脏并发症，510例患者（13%）发生非心脏并发症。40例患者（1%）同时发生两种并发症。最常见的心脏并发症是肺水肿（n = 42）和心肌梗死（n = 41）。最常见的非心脏并发症是伤口感染（n = 291）、意识障碍（n = 87）、需要插管的呼吸衰竭（n = 62）、深静脉血栓形成（n = 48）和细菌性肺炎（n = 46）。即使在对术前临床因素进行调整后，发生心脏并发症的患者比未发生心脏并发症的患者更易发生非心脏并发症（比值比 = 6.4；95%置信区间[CI]：3.9至10.6）。与无并发症的患者（4天；95%CI：3至4天）相比，发生心脏（11天；95%CI：9至12天）或非心脏（11天；95%CI：10至12天）并发症或两者皆有的患者，即使在对手术类型和临床因素进行调整后，平均住院时间也显著延长（15天；95%CI：12至18天）。
非心脏手术患者的心脏并发症和非心脏并发症密切相关。发生一种并发症的患者发生另一种并发症以及围手术期住院时间延长的风险增加。
