Department of Anaesthesia and Perioperative Medicine, Torbay Hospital, Torquay, UK
Department of Anaesthesia and Perioperative Medicine, Torbay Hospital, Torquay, UK.
Br J Anaesth. 2017 Jan;118(1):100-104. doi: 10.1093/bja/aew402.
Preoperative identification of high-risk surgical patients might help to reduce postoperative morbidity and mortality. Using a patient's predicted 30 day mortality to plan postoperative high-dependency unit (HDU) care after elective colorectal surgery might be associated with reduced postoperative morbidity.
The 30 day postoperative mortality was predicted for 504 elective colorectal surgical patients in a preoperative clinic. The prediction was used to determine postoperative surgical ward or HDU care. Those with a predicted 30 day mortality of 1-3% mortality, and thus deemed at intermediate risk, had either planned HDU care (n=68) or planned ward care (n=139). The main outcome measures were emergency laparotomy and unplanned critical care admission.
There were more emergency laparotomies and unplanned critical care admissions in patients with a predicted 30 day mortality of 1-3% who went to an HDU after surgery compared with patients who went to a ward: 0 vs 14 (10%), P=0.0056 and 0 vs 22 (16%), P=0.0002, respectively.
Planned postoperative critical care was associated with a lower rate of complications after elective colorectal surgery.
术前识别高危手术患者有助于降低术后发病率和死亡率。使用患者预测的 30 天死亡率来规划择期结直肠手术后的高依赖单位（HDU）护理，可能与降低术后发病率有关。
在术前诊所对 504 例择期结直肠手术患者进行了 30 天术后死亡率预测。该预测用于确定术后外科病房或 HDU 护理。预测 30 天死亡率为 1-3%，即被认为处于中危的患者，计划接受 HDU 护理（n=68）或计划接受病房护理（n=139）。主要观察指标为急诊剖腹手术和计划外重症监护入院。
与去病房的患者相比，去 HDU 的预测 30 天死亡率为 1-3%的患者有更多的急诊剖腹手术和计划外重症监护入院：0 比 14（10%），P=0.0056 和 0 比 22（16%），P=0.0002。
择期结直肠手术后计划接受术后重症监护与并发症发生率降低相关。
