Stepp Kevin J, Barber Matthew D, Yoo Eun-Hee, Whiteside James L, Paraiso Marie Fidela R, Walters Mark D
Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Ohio 44116, USA.
Am J Obstet Gynecol. 2005 May;192(5):1630-6. doi: 10.1016/j.ajog.2004.11.026.
The purpose of this study was to determine the incidence of and risk factors for perioperative complications in elderly women who undergo urogynecologic surgery.
A retrospective chart review of patients > or = 75 years old who underwent urogynecologic surgery between January 1999 and December 2003 was performed. Demographics, comorbidities, and significant perioperative complications were recorded. The Charlson Comorbidity Index and American Society of Anesthesiologists classification were calculated to summarize the patients' overall perioperative risk. Logistic regression was used to identify independent risk factors for perioperative complications.
Two hundred sixty-seven patients who were > or = 75 years old met the inclusion criteria; 25.8% of the patients had a significant perioperative complication. The most common perioperative complication was blood transfusion or significant blood loss, pulmonary edema, and postoperative congestive heart failure. Independent risk factors that were predictive of a patient having a perioperative complication were the length of surgery, coronary artery disease, and peripheral vascular disease. The Charlson Comorbidity Index and American Society of Anesthesiologists classification did not predict perioperative complications in this population.
Pre-existing cardiovascular disease increases the risk of a significant perioperative complication in elderly women who undergo urogynecologic surgery. However, the overall perioperative morbidity rate in elderly women who undergo urogynecologic surgery is low.
本研究旨在确定接受泌尿妇科手术的老年女性围手术期并发症的发生率及危险因素。
对1999年1月至2003年12月期间接受泌尿妇科手术的75岁及以上患者进行回顾性病历审查。记录人口统计学资料、合并症及围手术期重大并发症。计算Charlson合并症指数和美国麻醉医师协会分级以总结患者围手术期总体风险。采用逻辑回归分析确定围手术期并发症的独立危险因素。
267例75岁及以上患者符合纳入标准;25.8%的患者发生围手术期重大并发症。最常见的围手术期并发症为输血或大量失血、肺水肿及术后充血性心力衰竭。预测患者发生围手术期并发症的独立危险因素为手术时长、冠状动脉疾病及外周血管疾病。Charlson合并症指数和美国麻醉医师协会分级无法预测该人群的围手术期并发症。
既往存在的心血管疾病会增加接受泌尿妇科手术的老年女性发生围手术期重大并发症的风险。然而,接受泌尿妇科手术的老年女性围手术期总体发病率较低。