Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Am J Surg. 2012 Nov;204(5):586-90. doi: 10.1016/j.amjsurg.2012.07.014. Epub 2012 Aug 18.
The aim of this study was to characterize the impact of perioperative events on long-term mortality after major vascular surgery at a single institution.
A retrospective analysis of patients undergoing major vascular surgery was performed. The primary end point was all-cause long-term mortality. Cox regression analyses were performed to identify predictors of this outcome.
A total of 1,182 procedures in 706 patients were identified, including endovascular or open aortic aneurysm repair, open repair of aortoiliac or infrainguinal occlusive disease, amputations, and carotid endarterectomy. Perioperative cardiac and respiratory complications occurred in 4.9% and 1.4% of operations, respectively. On multivariate Cox regression analysis, adjusting for patient factors and operation performed, perioperative cardiac (hazard ratio, 5.3; 95% confidence interval, 1.7-15.9) and respiratory complications (hazard ratio, 5.01; 95% confidence interval, 1.48-16.98) were significant predictors of long-term mortality.
Although serious perioperative cardiac and respiratory events are infrequent, they have a significant impact on long-term mortality after major vascular surgery, even when adjusted for comorbidities and type of operation.
本研究旨在描述单一机构大型血管手术后围手术期事件对长期死亡率的影响。
对接受大型血管手术的患者进行回顾性分析。主要终点是全因长期死亡率。采用 Cox 回归分析确定该结果的预测因素。
共确定了 706 例患者的 1182 例手术，包括血管内或开放的主动脉瘤修复、开放的主髂或下肢闭塞性疾病修复、截肢和颈动脉内膜切除术。围手术期心脏和呼吸系统并发症分别发生在 4.9%和 1.4%的手术中。多变量 Cox 回归分析调整患者因素和手术类型后，围手术期心脏（风险比，5.3；95%置信区间，1.7-15.9）和呼吸系统并发症（风险比，5.01；95%置信区间，1.48-16.98）是长期死亡率的显著预测因素。
尽管严重的围手术期心脏和呼吸系统事件并不常见，但即使调整了合并症和手术类型，它们对大型血管手术后的长期死亡率仍有显著影响。
