Sakan Sanja, Pavlovic Daniela Bandic, Milosevic Milan, Virag Igor, Martinovic Petar, Dobric Ivan, Davila Slavko, Peric Mladen
Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia.
Injury. 2015 Nov;46 Suppl 6:S61-6. doi: 10.1016/j.injury.2015.10.051. Epub 2015 Nov 6.
Trauma hip fractures in elderly patients are associated with high postoperative long-term morbidity and mortality and premature death. The high mortality in these patients can be explained by various factors, including the fracture itself; the preoperative poor condition and comorbidities of these patients; the influence of stressors, such as surgery and type of anaesthesia, on the patient's condition; and the postoperative development of major complications, such as cardiac failure, pulmonary embolism, pneumonia, deep venous thrombosis and acute renal failure. Thus, the Surgical Apgar Score (SAS) could be a valuable tool for objective risk stratification of patients immediately after surgery, and to enable patients with higher risk to receive postoperative ICU care and good management both during and after the hospital stay.
The SAS was calculated retrospectively from the handwritten anaesthesia records of 43 trauma hip fracture patients treated operatively in the University Hospital Centre Zagreb over a 1-year period. The primary endpoints were the 30-days major postoperative complications and mortality, length of the ICU and hospital stay, and 6-months major complications development. Statistical analysis was applied to compare SAS with the patients' perioperative variables.
A SAS≤4 in the trauma hip fracture patients was a significant predictor for the 30-days major postoperative complications with 80% specificity (95% CI: 0.587-0.864, p=0.0111). However, the SAS was not significant in the prediction of 30-days mortality (95% CI: 0.468-0.771, p=0.2238) and 6-months mortality (95% CI: 0.497-0.795, p=0.3997) as primary endpoints in the hip fracture surgery patients.
The SAS shows how intraoperative events affect postoperative outcomes. Calculating the SAS in the operating theatre provides immediate, reliable, real-time feedback information about patient postoperative risk. The results of this study indicate that all trauma hip fracture patients with SAS≤4 should go to the ICU postoperatively and should be under intensive surveillance both during the hospital stay and after hospital discharge.
老年患者创伤性髋部骨折与术后长期高发病率、死亡率及过早死亡相关。这些患者的高死亡率可由多种因素解释，包括骨折本身；患者术前状况差及合并症；手术和麻醉类型等应激源对患者状况的影响；以及术后主要并发症的发生，如心力衰竭、肺栓塞、肺炎、深静脉血栓形成和急性肾衰竭。因此，手术阿普加评分（SAS）可能是术后即刻对患者进行客观风险分层的有价值工具，使高风险患者在住院期间及出院后能接受术后重症监护病房（ICU）护理及良好管理。
回顾性计算萨格勒布大学医院中心1年内接受手术治疗的43例创伤性髋部骨折患者手写麻醉记录中的SAS值。主要终点为术后30天主要并发症和死亡率、ICU及住院时间、6个月主要并发症发生情况。应用统计分析比较SAS与患者围手术期变量。
创伤性髋部骨折患者中，SAS≤4是术后30天主要并发症的显著预测指标，特异性为80%（95%可信区间：0.587 - 0.864，p = 0.0111）。然而，在髋部骨折手术患者中，以30天死亡率（95%可信区间：0.468 - 0.771，p = 0.2238）和6个月死亡率（95%可信区间：0.497 - 0.795，p = 0.3997）作为主要终点时，SAS的预测无显著性。
SAS显示了术中事件如何影响术后结果。在手术室计算SAS可提供关于患者术后风险的即时、可靠、实时反馈信息。本研究结果表明，所有SAS≤4的创伤性髋部骨折患者术后应进入ICU，住院期间及出院后均应接受密切监测。
