Warner M A, Hosking M P, Lobdell C M, Offord K P, Melton L J
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1990 Sep;65(9):1185-91. doi: 10.1016/s0025-6196(12)62742-6.
During the 11-year period 1975 through 1985, 1,063 surgical procedures were performed on 795 Mayo Clinic patients 90 years of age or older. Preoperative conditions, surgical setting, and perioperative morbidity and mortality were analyzed in a comparison of the local residents of Olmsted County, Minnesota (N = 224), with patients from outside the county but within 250 miles (N = 456) or referrals from a distance of 250 miles or further (N = 115). In comparison with non-Olmsted County patients, Olmsted County patients were generally older, had more preoperative chronic diseases, and underwent more emergency operations. Patients who had traveled 250 miles or more to the Mayo Clinic were more likely to be men and referred for cancer-related surgical procedures. The risks of major morbidity and mortality within 48 hours postoperatively were increased in patients with more preoperative chronic diseases and those undergoing emergency procedures, characteristics most common in Olmsted County patients. Because of differences in these factors between groups, perioperative risks averaged over our entire patient series underestimated risks that would be expected from a population-based cohort such as Olmsted County residents. In general, data from tertiary medical centers probably do not accurately reflect overall practice or outcomes in community settings.
在1975年至1985年的11年期间，梅奥诊所为795名90岁及以上的患者进行了1063例外科手术。对明尼苏达州奥尔姆斯特德县的当地居民（N = 224）、本县以外但距离在250英里以内的患者（N = 456）或来自250英里及更远距离的转诊患者（N = 115）进行了比较，分析了术前状况、手术环境以及围手术期的发病率和死亡率。与非奥尔姆斯特德县的患者相比，奥尔姆斯特德县的患者通常年龄更大，术前患有更多慢性疾病，并且接受急诊手术的比例更高。前往梅奥诊所路程超过250英里的患者更有可能是男性，并且是因癌症相关外科手术而转诊。术前患有更多慢性疾病的患者以及接受急诊手术的患者（这些特征在奥尔姆斯特德县患者中最为常见）术后48小时内发生严重发病和死亡的风险增加。由于各组之间这些因素存在差异，我们整个患者系列的围手术期平均风险低估了像奥尔姆斯特德县居民这样基于人群的队列所预期的风险。一般来说，三级医疗中心的数据可能无法准确反映社区环境中的总体医疗实践或结果。
