Division of GI, Tumor and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora.
Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora.
JAMA Surg. 2015 Jan;150(1):30-6. doi: 10.1001/jamasurg.2014.863.
With an aging population, preoperative assessment of the frail older adult requires evaluation beyond simply accounting for chronic diseases. Impaired cognition is a recognized characteristic of the frail older adult.
To examine the effect of preoperative impaired sensorium (IS) on general surgical outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using data between January 2005 and December 2010 at academic and community hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing nonemergent general surgical operations were studied. Multivariable logistic regression involving 45 preoperative patient-level risk factors and comorbidities was used to calculate the conditional probability of having IS. Patients having and not having preoperative IS were matched on their propensity scores using a 1:1 greedy matching technique. Propensity score matching resulted in almost all (n = 1765) patients with IS uniquely matching to a patient without IS, resulting in a cohort size of 3530. Complication rates between patients with and without IS were compared.
Rates of postoperative complications and death following nonemergent general surgical operations.
In total, 294 037 patients were studied, of whom 1771 (0.6%) had preoperative IS. Patients with IS were older and had more significant preoperative risk factors and comorbidities. As a result, unadjusted analysis found that 22 of 23 postoperative complications were significantly more likely to occur in patients with IS. Within the matched cohort, rates of postoperative pneumonia, ventilator dependence, progressive renal insufficiency, urinary tract infection, stroke, venous thromboembolism, and postoperative death continued to be significantly (P < .05) elevated in patients with IS.
Impaired sensorium significantly increases postoperative morbidity and mortality independent of other preoperative risk factors and comorbidities following nonemergent general surgical operations. Incorporation of impaired cognitive function into routine preoperative risk assessment and decision making could be an important addition to traditional risk assessment strategies.
随着人口老龄化，对虚弱的老年患者进行术前评估需要超越单纯考虑慢性疾病。认知障碍是虚弱的老年患者的一个公认特征。
研究术前感觉障碍（IS）对普通外科手术结果的影响。
设计、设置和参与者：这是一项回顾性队列研究，使用了 2005 年 1 月至 2010 年 12 月期间在参与美国外科医师学院国家外科质量改进计划的学术和社区医院的患者数据。研究对象为接受非紧急普通外科手术的患者。使用涉及 45 个术前患者水平风险因素和合并症的多变量逻辑回归计算出现 IS 的条件概率。使用 1:1 贪婪匹配技术根据倾向评分对患有和不患有术前 IS 的患者进行匹配。倾向评分匹配导致几乎所有（n=1765）患有 IS 的患者都与没有 IS 的患者进行了独特匹配，从而使队列大小达到 3530 例。比较了患有和不患有 IS 的患者之间的并发症发生率。
非紧急普通外科手术后的术后并发症和死亡发生率。
共研究了 294037 例患者，其中 1771 例（0.6%）有术前 IS。患有 IS 的患者年龄更大，术前风险因素和合并症更为严重。因此，未调整分析发现，IS 患者发生 23 种术后并发症中的 22 种的可能性明显更高。在匹配队列中，患有 IS 的患者术后肺炎、呼吸机依赖、进行性肾功能不全、尿路感染、中风、静脉血栓栓塞和术后死亡的发生率仍然显著升高（P<.05）。
IS 显著增加了非紧急普通外科手术后的术后发病率和死亡率，独立于其他术前风险因素和合并症。将认知功能障碍纳入常规术前风险评估和决策中可能是对传统风险评估策略的重要补充。
