van Laar Charlotte, TImman Simone T, Noyez Luc
Department of Cardio-Thoracic Surgery - 615, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
Health Qual Life Outcomes. 2017 Jan 7;15(1):5. doi: 10.1186/s12955-016-0576-6.
Physical activity (PA) reduces the risk of cardiovascular disease and physically active survivors of a cardiac event are at lower risk of recurrent events. We hypothesized that patients with a decreased PA, undergoing cardiac surgery, are at higher risk for a postoperative complicated recovery (PCR).
Three thousand three hundred eighty two patients undergoing elective cardiac surgery between January 2007 and December 2013 were included. The group was divided into three subgroups: group A, aged ≤ 65 years (N = 1329); group B, aged > 65 years and ≤ 75 years (N = 1250); and group C aged >75 years (N = 803). To assess PA, the criteria of the Corpus Christy Heart Project were used. A PCR consists of the occurrence of a major postoperative event, defined as any of the following complications: reoperation, deep sternal wound infection, renal failure, stroke, postoperative ventilation > 2 days, intensive care stay ≥ 5 days, hospital stay ≥ 10 days, or hospital mortality.
One thousand three hundred sixty seven patients (40%) were considered as patients with a decreased PA. Both in group B (p = 0.001) and in group C (p = 0.003), patients with a decreased PA were significantly associated with an increased risk of a PCR, which was not the case in group A (p = 0.28). Logistic regression analysis identified a decreased PA as an independent predictor for PCR in groups B (p = 0.003, odds 1.71) and C (p = 0.033, odds 1.48), but not in group A (p = 0.11, odds 0.71).
Decreased physical activity is an independent predictor for a PCR in patients aged 65 years or older undergoing elective cardiac surgery.
身体活动(PA)可降低心血管疾病风险,心脏事件后身体活动的幸存者再次发生事件的风险较低。我们假设,接受心脏手术且身体活动减少的患者术后发生复杂恢复(PCR)的风险更高。
纳入2007年1月至2013年12月期间接受择期心脏手术的3382例患者。该组分为三个亚组:A组,年龄≤65岁(N = 1329);B组,年龄>65岁且≤75岁(N = 1250);C组,年龄>75岁(N = 803)。采用科珀斯克里斯蒂心脏项目的标准评估身体活动。PCR包括术后发生的主要事件,定义为以下任何一种并发症:再次手术、深部胸骨伤口感染、肾衰竭、中风、术后通气>2天、重症监护病房停留≥5天、住院时间≥10天或医院死亡率。
1367例患者(40%)被认为是身体活动减少的患者。在B组(p = 0.001)和C组(p = 0.003)中,身体活动减少的患者与PCR风险增加显著相关,A组则不然(p = 0.28)。逻辑回归分析确定,身体活动减少是B组(p = 0.003,比值1.71)和C组(p = 0.033,比值1.48)中PCR的独立预测因素,但在A组中不是(p = 0.11,比值0.71)。
身体活动减少是65岁及以上接受择期心脏手术患者发生PCR的独立预测因素。