Smetana Gerald W, Lawrence Valerie A, Cornell John E
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Ann Intern Med. 2006 Apr 18;144(8):581-95. doi: 10.7326/0003-4819-144-8-200604180-00009.
The importance of clinical risk factors for postoperative pulmonary complications and the value of preoperative testing to stratify risk are the subject of debate.
To systematically review the literature on preoperative pulmonary risk stratification before noncardiothoracic surgery.
MEDLINE search from 1 January 1980 through 30 June 2005 and hand search of the bibliographies of retrieved articles.
English-language studies that reported the effect of patient- and procedure-related risk factors and laboratory predictors on postoperative pulmonary complication rates after noncardiothoracic surgery and that met predefined inclusion criteria.
The authors used standardized abstraction instruments to extract data on study characteristics, hierarchy of research design, study quality, risk factors, and laboratory predictors.
The authors determined random-effects pooled estimate odds ratios and, when appropriate, trim-and-fill estimates for patient- and procedure-related risk factors from studies that used multivariable analyses. They assigned summary strength of evidence scores for each factor. Good evidence supports patient-related risk factors for postoperative pulmonary complications, including advanced age, American Society of Anesthesiologists class 2 or higher, functional dependence, chronic obstructive pulmonary disease, and congestive heart failure. Good evidence supports procedure-related risk factors for postoperative pulmonary complications, including aortic aneurysm repair, nonresective thoracic surgery, abdominal surgery, neurosurgery, emergency surgery, general anesthesia, head and neck surgery, vascular surgery, and prolonged surgery. Among laboratory predictors, good evidence exists only for serum albumin level less than 30 g/L. Insufficient evidence supports preoperative spirometry as a tool to stratify risk.
For certain risk factors and laboratory predictors, the literature provides only unadjusted estimates of risk. Prescreening, variable selection algorithms, and publication bias limited reporting of risk factors among studies using multivariable analysis.
Selected clinical and laboratory factors allow risk stratification for postoperative pulmonary complications after noncardiothoracic surgery.
临床风险因素对术后肺部并发症的重要性以及术前检查用于分层风险的价值是存在争议的话题。
系统回顾非心胸外科手术前术前肺部风险分层的文献。
1980年1月1日至2005年6月30日的MEDLINE搜索以及对检索文章参考文献的手工检索。
报告患者和手术相关风险因素及实验室预测指标对非心胸外科手术后肺部并发症发生率影响的英文研究，且符合预先定义的纳入标准。
作者使用标准化的提取工具提取关于研究特征、研究设计层次、研究质量、风险因素和实验室预测指标的数据。
作者确定了随机效应合并估计比值比，并在适当情况下，对使用多变量分析的研究中的患者和手术相关风险因素进行修剪和填充估计。他们为每个因素指定了证据强度总结分数。有力证据支持与患者相关的术后肺部并发症风险因素，包括高龄、美国麻醉医师协会分级2级或更高、功能依赖、慢性阻塞性肺疾病和充血性心力衰竭。有力证据支持与手术相关的术后肺部并发症风险因素，包括主动脉瘤修复、非切除性胸外科手术、腹部手术、神经外科手术、急诊手术、全身麻醉、头颈外科手术、血管外科手术和长时间手术。在实验室预测指标中，只有血清白蛋白水平低于30 g/L有有力证据支持。证据不足支持将术前肺活量测定作为分层风险的工具。
对于某些风险因素和实验室预测指标，文献仅提供了未经调整的风险估计。预筛查、变量选择算法和发表偏倚限制了使用多变量分析的研究中风险因素的报告。
选定的临床和实验室因素可对非心胸外科手术后的术后肺部并发症进行风险分层。
