择期腹部大手术后的肺部术后并发症：一项队列研究。
Postoperative pulmonary complications following major elective abdominal surgery: a cohort study.
机构信息
West Midlands Research Collaborative, Academic Department of Surgery, School of Cancer Sciences, University of Birmingham, Birmingham, B15 2TH UK.
West Midlands Research Collaborative, Academic Department of Surgery, School of Cancer Sciences, University of Birmingham, Birmingham, B15 2TH UK ; Nottingham Oesophago-Gastric Unit, Nottingham University Hospitals, Nottingham, UK.
出版信息
Perioper Med (Lond). 2016 May 23;5:10. doi: 10.1186/s13741-016-0037-0. eCollection 2016.
BACKGROUND
Postoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality. The aim of this prospective, contemporary, multicentre cohort study of unselected patients undergoing major elective abdominal surgery was to determine the incidence and effects of PPC.
METHODS
Data on all major elective abdominal operations performed over a 2-week period in December 2014 were collected in six hospitals. The primary outcome measure of PPC at 7 days was used. Univariate and multivariate analyses were performed to investigate how different factors were associated with PPC and the effects of such complications.
RESULTS
Two hundred sixty-eight major elective abdominal operations were performed, and the internal validation showed that the data set was 99 % accurate. Thirty-two (11.9 %) PPC were reported at 7 days. PPC was more common in patients with a history of chronic obstructive pulmonary disease compared to those with no history (26.7 vs. 10.2 %, p < 0.001). PPC was not associated with other patient factors (e.g. age, gender, body mass index or other comorbidities), type/method of operation or postoperative analgesia. The risk of PPC appeared to increase with every additional minute of operating time independent of other factors (odds ratio 1.01 (95 % confidence intervals 1.00-1.02), p = 0.007). PPC significantly increase the length of hospital stay (10 vs. 3 days). Attendance to the emergency department within 30 days (27.3 vs. 10.6 %), 30-day readmission (21.7 vs. 9.9 %) and 30-day mortality (12.5 vs. 0.0 %) was higher in those with PPC.
CONCLUSIONS
PPC are common and have profound effects on outcomes. Strategies need to be considered to reduce PPC.
背景
术后肺部并发症（PPC）是围手术期发病率和死亡率高但报道较少的主要原因。本研究旨在确定 PPC 的发生率和影响，为此，我们对接受择期大型腹部手术的未选择患者进行了前瞻性、当代、多中心队列研究。
方法
在 2014 年 12 月的两周内，在六家医院收集了所有主要择期腹部手术的数据。主要的 PPC 结局测量指标为术后 7 天。使用单变量和多变量分析来研究不同因素与 PPC 的关系以及此类并发症的影响。
结果
共进行了 268 例择期大型腹部手术，内部验证表明数据集准确率为 99%。术后 7 天报告了 32 例（11.9%）PPC。与无病史的患者相比，有慢性阻塞性肺疾病病史的患者 PPC 更为常见（26.7%比 10.2%，p<0.001）。PPC 与其他患者因素（如年龄、性别、体重指数或其他合并症）、手术类型/方法或术后镇痛无关。PPC 的风险似乎随着手术时间的每增加一分钟而独立于其他因素而增加（优势比 1.01（95%置信区间 1.00-1.02），p=0.007）。PPC 显著增加了住院时间（10 天比 3 天）。在 30 天内到急诊就诊（27.3%比 10.6%）、30 天内再次入院（21.7%比 9.9%）和 30 天内死亡（12.5%比 0.0%）的风险在 PPC 患者中更高。
结论
PPC 很常见，对结局有深远影响。需要考虑策略来减少 PPC。
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