INCOR, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2009 May;64(5):387-92. doi: 10.1590/s1807-59322009000500003.
INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality.
This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5%.
Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050).
DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45%. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, and postoperative need for prolonged respiratory support.
介绍/目的：我们确定了在 80 岁以上患者中，其他手术程序与心脏手术搭桥术联合治疗的风险程度，并确定了能够最好地解释住院死亡率的风险因素。
这是一项观察性分析性历史队列研究，纳入 2000 年 1 月 1 日至 2005 年 1 月 1 日在我院接受手术的 80 岁以上患者。我们将目标人群分为以下两组：组 1 为未行联合手术的 80 岁以上搭桥患者，组 2 为行联合手术的 80 岁以上搭桥患者。统计分析包括独立样本 t 检验和多变量逻辑回归分析。显著性水平设为 5%。
单变量分析显示以下临床和统计学显著变量：住院死亡率（P=0.002）、糖尿病（P=0.017）、术前心内膜炎（P=0.001）、心源性休克（P=0.019）、主动脉内球囊反搏（IABP）使用（P=0.026）、术前风险评分（Parsonnet）（P<0.001）、与搭桥术相关的手术（P<0.001）、受影响的冠状动脉数量中等（P<0.001）、体外循环的使用（P<0.001）、体外循环时间（P<0.001）、远端吻合口数量（P=0.002）、移植物类型（P<0.001）、术后呼吸支持（P<0.001）、中风（P<0.001）、感染（P=0.002）、肌酐水平（P=0.018）和生活质量评分（P=0.050）。
讨论/结论：在 80 岁以上患者中，需要与心脏手术搭桥术相关的手术会使住院死亡率的绝对风险增加 45%。导致住院死亡率的变量包括术前心内膜炎、术前心源性休克、体外循环的使用、体外循环时间、术后肌酐水平和术后需要长时间呼吸支持。
