Yale University School of Medicine, New Haven, CT, USA.
Obstet Gynecol. 2011 Oct;118(4):785-93. doi: 10.1097/AOG.0b013e31822dac5d.
To estimate the association of age, medical comorbidities, functional status, and unintentional weight loss (as a marker of frailty) with postoperative complications in women undergoing major gynecologic surgery.
We conducted a cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 participant use data files to analyze gynecologic procedures. The primary outcome was a composite of 30-day major postoperative complications.
A total of 22,214 women were included in our final analysis. The overall prevalence of composite 30-day major postoperative complications was 3.7% (n=817). Age 80 years or older (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.25-2.58), dependent functional status (adjusted OR 2.37, 95% CI 1.53-3.68), and unintentional weight loss (adjusted OR 2.49, 95% CI 1.48-4.17) were significantly associated with postoperative morbidity after adjusting for diabetes mellitus (adjusted OR 1.44, 95% CI 1.15-1.79), known bleeding disorder (adjusted OR 2.29, 95% CI 1.49-3.52), morbid obesity (adjusted OR 1.77, 95% CI 1.45-2.17), ascites (adjusted OR 3.27, 95% CI 2.18-4.90), preoperative systemic infection (adjusted OR 3.02, 95% CI 2.03-4.48), procedures for gynecologic cancer (adjusted OR 1.60, 95% CI 1.27-2.0), disseminated cancer (adjusted OR 2.57, 95% CI 1.64-4.03), emergency procedures (adjusted OR 1.82, 95% CI 1.18-2.79), operative time more than 4 hours compared with less than 1 hour (adjusted OR 2.91, 95% CI 2.18-3.89), and wound class 4 compared with wound class 1 (adjusted OR 4.28, 95% CI 1.82-10.1).
Age 80 years or older, medical comorbidities, dependent functional status, and unintentional weight loss are associated with increased major postoperative complications after gynecologic procedures.
III.
评估年龄、合并症、功能状态和非故意体重减轻（作为脆弱性的标志）与接受主要妇科手术的女性术后并发症的关联。
我们对美国外科医师学院国家手术质量改进计划 2005-2009 年参与者使用数据文件进行了横断面分析，以分析妇科手术。主要结局是 30 天主要术后并发症的综合指标。
共有 22214 名女性纳入我们的最终分析。复合 30 天主要术后并发症的总体患病率为 3.7%（n=817）。80 岁或以上年龄（调整后的优势比[OR] 1.8，95%置信区间[CI] 1.25-2.58）、依赖性功能状态（调整后的 OR 2.37，95% CI 1.53-3.68）和非故意体重减轻（调整后的 OR 2.49，95% CI 1.48-4.17）在调整糖尿病（调整后的 OR 1.44，95% CI 1.15-1.79）、已知出血性疾病（调整后的 OR 2.29，95% CI 1.49-3.52）、病态肥胖（调整后的 OR 1.77，95% CI 1.45-2.17）、腹水（调整后的 OR 3.27，95% CI 2.18-4.90）、术前全身感染（调整后的 OR 3.02，95% CI 2.03-4.48）、妇科癌症手术（调整后的 OR 1.60，95% CI 1.27-2.0）、播散性癌症（调整后的 OR 2.57，95% CI 1.64-4.03）、紧急手术（调整后的 OR 1.82，95% CI 1.18-2.79）、手术时间超过 4 小时与少于 1 小时（调整后的 OR 2.91，95% CI 2.18-3.89）和伤口等级 4 与伤口等级 1（调整后的 OR 4.28，95% CI 1.82-10.1）相比，术后主要并发症的风险增加。
80 岁或以上年龄、合并症、依赖性功能状态和非故意体重减轻与妇科手术后主要术后并发症的增加有关。
III。
