Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
School of Public Health, Curtin University, Perth, Western Australia, Australia.
Anaesthesia. 2017 Dec;72(12):1467-1475. doi: 10.1111/anae.13967. Epub 2017 Jul 13.
Acute risk change has been described as the difference in calculated mortality risk between the pre-operative and postoperative periods of cardiac surgery. We aimed to assess whether this was associated with long-term survival after cardiac surgery. We retrospectively analysed 22,570 cardiac surgical patients, with minimum and maximum follow-up of 1.0 and 6.7 years. Acute risk change was calculated as the arithmetic difference between pre- and postoperative mortality risk. 'Rising risk' represented an increase in risk from pre- to postoperative phase. The primary outcome was one-year mortality. Secondary outcomes included mortality at 3 and 5 years and time to death. Univariable and multivariable analyses were undertaken to examine the relationship between acute risk change and outcomes. Rising risk was associated with higher mortality (5.6% vs. 3.5%, p < 0.001). After adjusting for baseline risk, rising risk was independently associated with increased 1-year mortality (OR 2.6, 95%CI 2.2-3.0, p < 0.001). The association of rising risk with long-term survival was greatest in patients with highest baseline risk. Cox regression confirmed rising risk was associated with shorter time to death (HR 1.86, 1.68-2.05, p < 0.001). Acute risk change may represent peri-operative clinical events in combination with unmeasured patient risk and noise. Measuring risk change could potentially identify patterns of events that may be amenable to investigation and intervention. Further work with case review, and risk scoring with shared variables, may identify mechanisms, including the interaction between miscalibration of risk and true differences in peri-operative care.
急性风险变化是指心脏手术后术前和术后计算出的死亡率风险之间的差异。我们旨在评估这种差异是否与心脏手术后的长期生存相关。我们回顾性分析了 22570 例心脏手术患者，最小和最大随访时间分别为 1.0 年和 6.7 年。急性风险变化是通过计算术前和术后死亡率风险之间的算术差来计算的。“风险上升”表示风险从术前阶段到术后阶段的增加。主要结果是 1 年死亡率。次要结果包括 3 年和 5 年死亡率以及死亡时间。进行单变量和多变量分析以检查急性风险变化与结局之间的关系。风险上升与死亡率升高相关（5.6% vs. 3.5%，p<0.001）。在校正基线风险后，风险上升与 1 年死亡率增加独立相关（OR 2.6，95%CI 2.2-3.0，p<0.001）。在基线风险最高的患者中，风险上升与长期生存的相关性最大。Cox 回归证实，风险上升与死亡时间缩短相关（HR 1.86，1.68-2.05，p<0.001）。急性风险变化可能代表围手术期临床事件与未测量的患者风险和噪声的组合。测量风险变化可能可以识别可能适合调查和干预的事件模式。通过病例回顾和使用共享变量进行风险评分进一步工作，可能会确定机制，包括风险校准错误和围手术期护理真实差异之间的相互作用。
