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[手术再次干预术前检查正常结果的有效期及其对术后结局的影响]

[Validity time of normal results of preoperative tests for surgical reintervention and the impact on postoperative outcomes].

作者信息

Ramos Lafayete William Ferreira, Souza Cristiano F, Dias Ivan Wilson Hossni, Oliveira Rogério G, Cristina Bárbara, Calil Marcelo, Góes João Carlos Sampaio

机构信息

Instituto Brasileiro de Controle do Câncer, São Paulo, SP, Brasil; Faculdade de Medicina São Camilo, São Paulo, SP, Brasil.

Instituto Brasileiro de Controle do Câncer, São Paulo, SP, Brasil.

出版信息

Braz J Anesthesiol. 2018 Mar-Apr;68(2):154-161. doi: 10.1016/j.bjan.2017.10.004. Epub 2017 Nov 12.

Abstract

BACKGROUND AND OBJECTIVE

There are few data defining the period of time in which preoperative tests can be considered valid. The purpose of this study was to determine the likelihood of changes in the results of preoperative tests previously normal in relation to time, and the impact of these changes on postoperative outcomes.

METHODS

A total of 970 patients with normal preoperative tests before the first surgery and who required a new intervention were included. The preoperative tests performed for the first procedure were compared with those performed for the second procedure. The following variables were assessed regarding their potential to induce changes in test results: sex, age, surgical risk, previous chemotherapy or radiotherapy, and presence of comorbidities. In-hospital outcomes were analyzed.

RESULTS

The median time between procedures was 27 months (6–84). The probability of change in at least one of the preoperative exams was 1.7% (95% CI: 0.5–2.9), 3.6% (95% CI: 1.8–5.4), and 6.4% (95% CI: 3.9–8.9) during the 12, 24, and 36-month intervals, respectively, for patients aged <50 years and 2.1% (95% CI: 0.7–3.5), 9.2% (95% CI: 5.9–12.5), and 13.4% (95% CI: 9.3–17.5), respectively, for patients ≥50 years of age. Age ( = 0.009), surgical risk ( < 0.001), chemotherapy ( = 0.001), radiotherapy ( = 0.012), and comorbidities ( < 0.001) were associated with the likelihood of changes in test results. Test changes were not significantly associated with in-hospital adverse outcomes ( = 0.426).

CONCLUSION

For patients undergoing a second surgical procedure, the probability of change in previously normal preoperative tests is low during the first years after the first surgical intervention, and when changes occurred, they did not adversely affect the in-hospital postoperative outcomes.

摘要

背景与目的

关于术前检查结果可被视为有效的时间段,相关数据较少。本研究的目的是确定术前检查结果先前正常的情况下,其结果随时间变化的可能性,以及这些变化对术后结局的影响。

方法

共纳入970例首次手术前术前检查正常且需要再次干预的患者。将首次手术时进行的术前检查与第二次手术时进行的术前检查进行比较。评估以下变量诱导检查结果变化的可能性:性别、年龄、手术风险、既往化疗或放疗情况以及合并症情况。分析住院结局。

结果

两次手术之间的中位时间为27个月(6 - 84个月)。年龄<50岁的患者在12个月、24个月和36个月间隔期内,至少一项术前检查结果发生变化的概率分别为1.7%(95%CI:0.5 - 2.9)、3.6%(95%CI:1.8 - 5.4)和6.4%(95%CI:3.9 - 8.9);年龄≥50岁的患者相应概率分别为2.1%(95%CI:0.7 - 3.5)、9.2%(95%CI:5.9 - 12.5)和13.4%(95%CI:9.3 - 17.5)。年龄(P = 0.009)、手术风险(P < 0.001)、化疗(P = 0.001)、放疗(P = 0.012)和合并症(P < 0.001)与检查结果变化的可能性相关。检查结果变化与住院不良结局无显著相关性(P = 0.426)。

结论

对于接受二次手术的患者,在首次手术干预后的头几年,先前正常的术前检查结果发生变化的概率较低,并且当发生变化时,它们不会对住院术后结局产生不利影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3630/9391796/0f7d16d9a647/gr1.jpg

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