手术时间延长对游离组织移植术后早期失败和并发症发生率的影响？对来自美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库的2008例患者进行的风险因素分析。

Impact of increasing operative time on the incidence of early failure and complications following free tissue transfer? A risk factor analysis of 2,008 patients from the ACS-NSQIP database.

作者信息

Offodile Anaeze C, Aherrera Andrew, Wenger Julia, Rajab Taufiek K, Guo Lifei

机构信息

Department of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, MA.

Department of Nephrology, Massachusetts General Hospital, Boston, MA.

出版信息

Microsurgery. 2017 Jan;37(1):12-20. doi: 10.1002/micr.22387. Epub 2015 Mar 6.

DOI:10.1002/micr.22387

PMID:25752264

Abstract

BACKGROUND

There is a scarcity of externally valid data that investigate the utility of operative time, a common clinical parameter, as a predictor of free flap failures. Our aim was to assess whether prolonged operative time correlates with early flap failure following free tissue transfer in the acute care setting using the American College of Surgeons National Surgical Quality Improvement Program database.

METHODS

The 2005-2011 American College of Surgeons National Surgical Quality Improvement Program databases were reviewed for encounters that entailed a free tissue transfer via a CPT algorithm. Patients identified as having a flap loss were compared with people who did not with regards to operative time and patient comorbidities. Patients were subdivided into the following cohort groups with regards to operative time: <6 hours, 6-12 hours, and >12 hours. Secondary outcome was association between increasing operative time and postoperative complications.

RESULTS

Of the 2,008 patients identified, 62 (3.1%) had early flap failure. After multivariable analysis, it was found that progressive operative time was associated with an increased risk of flap failure; 6-12 hours odds ratio was 4.64 and >12 hours odds ratio was 5.65 (P = 0.0140). Higher American Society of Anesthesiologists class (P = 0.0042) was also shown to be significantly associated with flap failure. On secondary analysis, increasing operative time was correlated with the following complications: pneumonia, blood transfusions, prolonged ventilation, wound dehiscence, and wound complications.

CONCLUSION

Our results, one of the largest series in the literature, revealed that prolonged operative time was associated with a stepwise increase in the likelihood of early flap failure as well certain postoperative complications. © 2014 Wiley Periodicals, Inc. Microsurgery 37:12-20, 2017.

摘要

背景

目前缺乏外部有效数据来研究手术时间这一常见临床参数作为游离皮瓣失败预测指标的效用。我们的目的是利用美国外科医师学会国家外科质量改进计划数据库，评估在急性护理环境下，手术时间延长是否与游离组织移植术后早期皮瓣失败相关。

方法

回顾2005 - 2011年美国外科医师学会国家外科质量改进计划数据库中通过CPT算法进行游离组织移植的病例。将确定发生皮瓣丢失的患者与未发生皮瓣丢失的患者在手术时间和患者合并症方面进行比较。根据手术时间将患者分为以下队列组：<6小时、6 - 12小时和>12小时。次要结果是手术时间增加与术后并发症之间的关联。

结果

在确定的2008例患者中，62例（3.1%）发生早期皮瓣失败。多变量分析后发现，手术时间延长与皮瓣失败风险增加相关；6 - 12小时的比值比为4.64，>12小时的比值比为5.65（P = 0.0140）。较高的美国麻醉医师协会分级（P = 0.0042）也显示与皮瓣失败显著相关。在次要分析中，手术时间增加与以下并发症相关：肺炎、输血、通气时间延长、伤口裂开和伤口并发症。