非心脏大手术30天和1年死亡率的预测因素
Thirty-day and one-year predictors of death in noncardiac major surgical procedures.
作者信息
Kaafarani Haytham M A, Itani Kamal M F, Thornby Jack, Berger David H
机构信息
Michael E. DeBakey Veteran Affairs Medical Center and Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
出版信息
Am J Surg. 2004 Nov;188(5):495-9. doi: 10.1016/j.amjsurg.2004.07.018.
BACKGROUND
We evaluated the predictive value of the American College of Cardiology/American Heart Association (ACC/AHA) cardiac risk classification, as well as other potential risk factors (procedure risk, smoking, obesity, hyperlipidemia, and renal insufficiency), on all-cause mortality at 30 days and at 1 year postoperatively.
METHODS
In the year 2000, 1238 consecutive patients undergoing general anesthesia for various noncardiac surgical procedures at the Houston Veterans Affairs Medical Center were screened preoperatively and classified according to the ACC/AHA guidelines. Patients' charts were reviewed for the above-mentioned risk factors.
RESULTS
A logistic regression analysis demonstrated that older age and higher procedure risk were associated with higher 30-day mortalities (P = 0.0012 and 0.0441, respectively). The ACC/AHA classification was positively correlated with mortality at 1 year (P = 0.0071).
CONCLUSIONS
The ACC/AHA classification predicts mortality at 1 year but not at 30 days for major noncardiac surgeries; procedure-related risk is a better predictor of 30-day postoperative mortality in our patient population.
背景
我们评估了美国心脏病学会/美国心脏协会（ACC/AHA）心脏风险分类以及其他潜在风险因素（手术风险、吸烟、肥胖、高脂血症和肾功能不全）对术后30天和1年全因死亡率的预测价值。
方法
2000年，对休斯顿退伍军人事务医疗中心1238例因各种非心脏手术接受全身麻醉的连续患者进行术前筛查，并根据ACC/AHA指南进行分类。查阅患者病历以了解上述风险因素。
结果
逻辑回归分析表明，年龄较大和手术风险较高与30天死亡率较高相关（分别为P = 0.0012和0.0441）。ACC/AHA分类与1年死亡率呈正相关（P = 0.0071）。
结论
对于大型非心脏手术，ACC/AHA分类可预测1年死亡率，但不能预测30天死亡率；在我们的患者群体中，与手术相关的风险是术后30天死亡率更好的预测指标。
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