Greenstein Alexander J, Chassin Mark R, Wang Jason, Rockman Caron B, Riles Thomas S, Tuhrim Stanley, Halm Ethan A
Department of Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Vasc Surg. 2007 Dec;46(6):1138-44; discussion 1145-6. doi: 10.1016/j.jvs.2007.08.026.
Most studies on outcomes of carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications.
The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications < or =30 days of surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with chi(2) tests and multivariate logistic regression.
The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10% of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5%; hematoma, 5.0%; and wound infection, 0.2%). Cardiac complications occurred in 3.9% (myocardial 1.1%, unstable angina 0.9%, pulmonary edema 2.1%, and ventricular tachycardia 0.8%). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke (P < 0.0001). Patients with cardiac complications had 4 to 5-fold increased odds of stroke or combined risk of death and stroke.
Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.
大多数关于颈动脉内膜切除术（CEA）预后的研究都集中在死亡和中风等主要并发症上。对于血肿、颅神经麻痹和伤口感染等较小但更常见的手术并发症了解较少。本研究使用了一项基于人群的大型队列研究的数据，以描述CEA后小手术并发症的发生率，并研究小并发症与大并发症之间的关联。
纽约颈动脉手术（NYCAS）研究调查了1998年1月至1999年6月在纽约州接受CEA的所有医疗保险受益人。从医院病历中提取了术前特征和手术≤30天并发症的详细临床信息。使用卡方检验和多因素逻辑回归分析小并发症（颅神经麻痹、血肿和伤口感染）与大并发症（死亡/中风）之间的关联。
NYCAS研究有167家医院的482名外科医生进行的9308例CEA的数据。总体而言，10%的患者有小手术并发症（颅神经（CN）麻痹，5.5%；血肿，5.0%；伤口感染，0.2%）。心脏并发症发生率为3.9%（心肌梗死1.1%，不稳定型心绞痛0.9%，肺水肿2.1%，室性心动过速0.8%）。在未调整和调整分析中，任何小手术并发症、单独的CN麻痹或单独的血肿的发生与围手术期中风或死亡和非致命性中风联合风险的几率高3至4倍相关（P<0.0001）。有心脏并发症的患者中风或死亡和中风联合风险的几率增加4至5倍。
CEA后小手术并发症很常见，且与更高的死亡和中风风险相关。患者因素、过程因素和直接因果关系都参与了这种关系，但未来还需要开展更多工作以更好地了解它们的相对作用。
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