Gulack Brian C, Hale Betsy, White William D, Moon Richard E, Bennett-Guerrero Elliott
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
J Surg Res. 2017 Apr;210:152-158. doi: 10.1016/j.jss.2016.10.025. Epub 2016 Nov 4.
Marriage is linked to substantial societal and economic benefits, and it has been associated with improved outcomes following acute illness. However, it is not known if being married confers benefit to patients undergoing noncardiac surgical procedures.
Patients undergoing any noncardiac surgical procedure were included over a period of 19 months. All-cause mortality at 2 years was determined by linking patient records to the National Death Index. Risk adjustment was performed using Cox modeling and the Cleveland Clinic risk stratification index.
Of the 11,588 patients included, 7830 (68.0%) were married at the time of surgery. There was a significant interaction between sex and marital status (P = 0.03), so the remainder of the analysis was performed separately by sex. Among men, not being married was associated with significantly worse survival (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.06, 1.63), whereas among women, there was no significant association between marital status and survival (HR: 0.94, 95% CI: 0.77, 1.15). Furthermore, divorced men (HR: 1.76, 95% CI: 1.25, 2.51) and never married men (HR: 1.53, 95% CI: 1.14, 2.05) had significantly worse survival than married men, whereas there was no significant difference between widowed men and married men, nor when comparing widowed, divorced, or never married women to married women.
Among a diverse group of surgical patients, being married at the time of surgery is associated with significantly improved survival only among men. Focused efforts to improve social support for unmarried male patients may improve outcomes.
婚姻与大量的社会和经济效益相关，并且与急性病后改善的预后有关。然而，尚不清楚已婚是否会给接受非心脏外科手术的患者带来益处。
纳入在19个月期间接受任何非心脏外科手术的患者。通过将患者记录与国家死亡指数相链接来确定2年时的全因死亡率。使用Cox模型和克利夫兰诊所风险分层指数进行风险调整。
在纳入的11588例患者中，7830例（68.0%）在手术时已婚。性别与婚姻状况之间存在显著交互作用（P = 0.03），因此其余分析按性别分别进行。在男性中，未婚与显著更差的生存率相关（风险比[HR]：1.31，95%置信区间[CI]：1.06，1.63），而在女性中，婚姻状况与生存率之间无显著关联（HR：0.94，95% CI：0.77，1.15）。此外，离婚男性（HR：1.76，95% CI：1.25，2.51）和从未结婚男性（HR：1.53，95% CI：1.14，2.05）的生存率显著低于已婚男性，而丧偶男性与已婚男性之间无显著差异，将丧偶、离婚或从未结婚的女性与已婚女性进行比较时也无显著差异。
在不同类型的外科手术患者中，仅在男性中手术时已婚与显著改善的生存率相关。集中精力改善对未婚男性患者的社会支持可能会改善预后。
