van de Pol Marleen A, van Houdenhoven Mark, Hans Erwin W, Boersma Eric, Bax Jeroen J, Feringa Harm H H, Schouten Olaf, van Sambeek Marc R H M, Poldermans Don
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2006 May 15;97(10):1423-6. doi: 10.1016/j.amjcard.2005.12.032. Epub 2006 Mar 23.
Major vascular surgery is associated with a long in-hospital length of stay (LOS). Cardiac risk factors identify patients with an increased risk. Recent studies have associated statin, aspirin, and beta-blocker therapies with improved postoperative outcome. However, the effect of all these factors on LOS has not been defined. Our aims were to determine the effect of cardiac risk factors and (preventive) statin, aspirin, and beta-blocker therapy on LOS and to deduce from these factors a model that predicts LOS. In total, 2,374 patients from 1990 to 2004 were enrolled. Mean LOS was 18 +/- 9 days. Cardiac risk factors that were significantly associated with LOS in the multivariable analysis were age, previous heart failure, hypertension, diabetes mellitus, renal failure, and chronic obstructive pulmonary disease. Statin and aspirin use was associated with a shorter LOS. Beta blockers shortened LOS only in patients with underlying coronary artery disease. Together, these factors explained 14.1% of the variance in LOS. In conclusion, in-hospital LOS in patients who undergo major vascular surgery can be predicted more accurately by clinical cardiac risk factors. A significant decrease in in-hospital LOS was achieved with statin, aspirin, and beta-blocker therapies.
大血管手术与较长的住院时间相关。心脏危险因素可识别出风险增加的患者。近期研究表明他汀类药物、阿司匹林和β受体阻滞剂治疗与改善术后结局有关。然而,所有这些因素对住院时间的影响尚未明确。我们的目的是确定心脏危险因素以及(预防性)他汀类药物、阿司匹林和β受体阻滞剂治疗对住院时间的影响,并从这些因素中推导一个预测住院时间的模型。总共纳入了1990年至2004年的2374例患者。平均住院时间为18±9天。多变量分析中与住院时间显著相关的心脏危险因素包括年龄、既往心力衰竭、高血压、糖尿病、肾衰竭和慢性阻塞性肺疾病。使用他汀类药物和阿司匹林与较短的住院时间相关。β受体阻滞剂仅在患有潜在冠状动脉疾病的患者中缩短了住院时间。这些因素共同解释了住院时间变异的14.1%。总之,临床心脏危险因素可更准确地预测接受大血管手术患者的住院时间。他汀类药物、阿司匹林和β受体阻滞剂治疗可显著缩短住院时间。