Harris Donald G, Herrera Anthony, Drucker Charles B, Kalsi Richa, Menon Nandakumar, Toursavadkohi Shahab, Diaz Jose J, Crawford Robert S
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md; University of Maryland R. Adams Cowley Shock Trauma Center, Baltimore, Md.
J Vasc Surg. 2017 Nov;66(5):1511-1517. doi: 10.1016/j.jvs.2017.04.060. Epub 2017 Jun 26.
The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland.
A retrospective analysis of a statewide inpatient database was performed to identify patients undergoing noncardiac vascular procedures in Maryland from 2009 to 2013. Patients were stratified by admission acuity as elective, urgent, or emergent, with the last two groups defined as acute. The primary outcome was inpatient mortality, and secondary outcomes were critical care and hospital resource requirements. Groups were compared by univariate analyses, with multivariable analysis of mortality based on acuity level and other potential risk factors for death.
Of 3,157,499 adult hospital admissions, 154,004 (5%) patients underwent a vascular procedure; most were acute (54% emergent, 13% urgent), whereas 33% were elective. Acute patients had higher rates of critical care morbidity and required more hospital resource utilization. Admission for acute vascular surgery was independently associated with mortality (urgent odds ratio, 2.1; emergent odds ratio, 3.0).
The majority of inpatient vascular care in Maryland is for acute vascular surgery, which is an independent risk factor for mortality. Acute vascular surgical care entails greater critical care and hospital resource utilization and-similar to emergency general surgery-may benefit from dedicated training and practice models.
急性护理手术模式已经彻底改变了非选择性普通外科手术。同样，非选择性血管外科手术可能会从特定的管理和资源能力中受益。为了确定血管急性护理手术的负担和范围，我们分析了马里兰州因血管外科手术住院患者的特征和结局。
对全州住院患者数据库进行回顾性分析，以确定2009年至2013年在马里兰州接受非心脏血管手术的患者。患者按入院急症程度分为择期、紧急或急诊，后两组定义为急性。主要结局是住院死亡率，次要结局是重症监护和医院资源需求。通过单因素分析对各组进行比较，并基于急症程度和其他潜在死亡风险因素对死亡率进行多因素分析。
在3157499例成人住院患者中，154004例（5%）接受了血管手术；大多数是急性手术（54%为急诊，13%为紧急），而33%为择期手术。急性手术患者的重症监护发病率较高，需要更多的医院资源利用。急性血管手术入院与死亡率独立相关（紧急手术比值比为2.1；急诊手术比值比为3.0）。
马里兰州大多数住院血管护理是针对急性血管手术，这是死亡率的一个独立危险因素。急性血管手术护理需要更多的重症监护和医院资源利用，并且——与急诊普通外科手术类似——可能会从专门的培训和实践模式中受益。
