Sanders Julie, Cooper Jackie, Mythen Michael G, Montgomery Hugh E
St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Institute for Sport, Exercise and Health, University College London, 1st Floor 170 Tottenham Court Rd, London, W1T 7HA UK.
Perioper Med (Lond). 2017 Feb 14;6:2. doi: 10.1186/s13741-017-0060-9. eCollection 2017.
Post-operative morbidity affects up to 36% of cardiac surgical patients. However, few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool for describing and scoring (0-13) total morbidity burden after cardiac surgery, derived by noting the presence/absence of 13 morbidity domains on days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may suggest targets for intervention to reduce morbidity and healthcare costs. Thus, we explored the association of C-POMS with previously identified predictors of post-operative morbidity.
A systematic literature review of pre-operative risk assessment models for post-operative morbidity was conducted to identify variables associated with post-operative morbidity. The association of those variables with C-POMS was explored in patients drawn from the original C-POMS study ( = 444).
Seventy risk factors were identified, of which 56 were available in the study and 49 were suitable for analysis. Numbers were too few to analyse associations on D15. Thirty-three (67.3%) and 20 (40.8%) variables were associated with C-POMS on at least 1 or 2 days, respectively. Pre-operative albumin concentration, left ventricular ejection fraction and New York Heart Association functional class were associated with C-POMS on all days. Of the 16 independent risk factors, pre-operative albumin and haemoglobin concentrations and weight are potentially modifiable.
Different risk factors are associated with total morbidity burden on different post-operative days. Pre-operative albumin and haemoglobin concentrations and weight were independently predictive of post-operative total morbidity burden suggesting therapeutic interventions aimed at these might reduce both post-operative morbidity risk and health-care costs in patients undergoing cardiac surgery.
术后发病影响高达36%的心脏手术患者。然而，尽管患者希望了解与手术相关的所有风险，但很少有国家能可靠地记录发病结果数据。心脏术后发病评分（C-POMS）是一种用于描述和评分（0-13分）心脏手术后总发病负担的新工具，通过记录术后第3、5、8和15天13个发病领域的存在/不存在情况得出。识别可改变的C-POMS风险因素可能提示干预靶点，以降低发病率和医疗成本。因此，我们探讨了C-POMS与先前确定的术后发病预测因素之间的关联。
对术后发病的术前风险评估模型进行系统文献综述，以确定与术后发病相关的变量。在来自原始C-POMS研究（n = 444）的患者中探讨这些变量与C-POMS的关联。
共识别出70个风险因素，其中56个在研究中可用，49个适合分析。第15天的病例数太少，无法分析关联。分别有33个（67.3%）和20个（40.8%）变量在至少1天或2天与C-POMS相关。术前白蛋白浓度、左心室射血分数和纽约心脏协会功能分级在所有天数均与C-POMS相关。在16个独立风险因素中，术前白蛋白和血红蛋白浓度以及体重可能是可改变的。
不同的风险因素与术后不同天数的总发病负担相关。术前白蛋白和血红蛋白浓度以及体重可独立预测术后总发病负担，这表明针对这些因素的治疗干预可能降低心脏手术患者的术后发病风险和医疗成本。
