Mehaffey J Hunter, Politano Amani D, Bhamidipati Castigliano M, Tracci Margaret C, Cherry Kenneth J, Kern John A, Kron Irving L, Upchurch Gilbert R
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA.
Surgery. 2017 Jun;161(6):1720-1727. doi: 10.1016/j.surg.2017.02.002. Epub 2017 Mar 18.
While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown.
Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non-decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition.
A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non-decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non-decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non-decubitus ulcer cohort (non-decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001).
Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.
虽然预计褥疮对血管手术后的预后有害，但围手术期褥疮在血管外科中的当代影响仍不明确。
使用全国住院患者调查，选取所有接受血管手术的成年患者。患者按是否存在褥疮（非褥疮患者）进行分层。采用病例组合调整分层混合模型研究住院死亡率、任何并发症的发生情况及出院处置。
共分析了538,808例病例。褥疮在白人男性医疗保险受益人中最为普遍（P <.001）。褥疮患者也接受了更多的非选择性血管手术（P <.001）。伤口、感染和手术并发症在褥疮患者中更为常见（P <.001）。未能挽救（定义为任何并发症后的死亡率）在褥疮患者中增加了一倍多（非褥疮患者：1.5%，褥疮患者：3.2%，P <.001）。同样，接受血管手术且有褥疮的患者未调整死亡率也增加了一倍（非褥疮患者：3%，褥疮患者：6%，P <.001）。在所有患者进行风险调整后，褥疮的存在或特定溃疡分期均未增加调整后的死亡几率。有褥疮会增加转至中级护理机构的调整几率（优势比2.9，P <.001）。与非褥疮患者队列相比，这些患者的总费用是其1.6倍（非褥疮患者：49,460美元±281美元，褥疮患者：81,149美元±5,855美元，P <.001）。
与普遍看法相反，围手术期褥疮对接受手术干预的血管手术患者的死亡率没有不利影响。然而，褥疮患者发生并发症的风险更高，且会产生相当大的额外费用。
