Kirshenbaum Eric J, Blackwell Robert H, Li Belinda, Kothari Anai N, Kuo Paul C, Flanigan Robert C, Gorbonos Alex, Gupta Gopal N
Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA.
Can J Urol. 2018 Feb;25(1):9186-9192.
The purpose of this article is to assess the incidence of pulmonary aspiration following major urologic surgery, predictors of an aspiration event, and subsequent clinical outcomes.
The Healthcare Cost and Utilization Project State Inpatient Database for California between 2007-2011 was used to identify cystectomy, prostatectomy, partial and radical nephrectomy patients. Aspiration events were identified within 30 days of surgery. The primary outcome was 30 day mortality and secondary outcomes included total length of stay, discharge location, and diagnoses of acute renal failure, pneumonia or sepsis. Descriptive statistics were performed. A multivariable logistic regression was performed to determine independent predictors of an aspiration event. A separate nonparsimonious logistic regression was fit to determine the independent effect of an aspiration event on 30 day mortality.
Of 84,837 major urologic surgery patients 319 (0.4%) had an aspiration event. Risk factors for aspiration included ileus, congestive heart failure, paraplegia, chronic lung disease, and age = 80 years (all p < 0.01). Aspiration patients had higher rates of renal failure (36.1% versus 2.5%), pneumonia (36.1% versus 2.5%), sepsis (35.7% versus 0.7%), a prolonged length of stay (17 days versus 3 days), and discharge to nursing facility(26.3% vs 2.3%) (all p<0.001). The 30 day mortality rate following aspiration was 20.7% compared to 0.8% (p < 0.001). Aspiration independently increases the risk of 30 day mortality (OR 3.1 (95%CI 2.2-4.5).
Postoperative aspiration following major urologic surgery is a devastating complication and precautions must be undertaken in high risk patient populations to avoid such an event.
本文旨在评估大型泌尿外科手术后肺误吸的发生率、误吸事件的预测因素以及随后的临床结局。
利用2007年至2011年加利福尼亚州医疗费用和利用项目国家住院患者数据库，识别接受膀胱切除术、前列腺切除术、部分肾切除术和根治性肾切除术的患者。在术后30天内识别误吸事件。主要结局是30天死亡率，次要结局包括总住院时间、出院地点以及急性肾衰竭、肺炎或败血症的诊断。进行了描述性统计。进行多变量逻辑回归以确定误吸事件的独立预测因素。拟合了一个单独的非简约逻辑回归，以确定误吸事件对30天死亡率的独立影响。
在84837例大型泌尿外科手术患者中，319例（0.4%）发生了误吸事件。误吸的危险因素包括肠梗阻、充血性心力衰竭、截瘫、慢性肺病以及年龄≥80岁（所有p<0.01）。误吸患者的肾衰竭发生率更高（36.1%对2.5%）、肺炎发生率更高（36.1%对2.5%）、败血症发生率更高（35.7%对0.7%）、住院时间更长（17天对3天）以及出院到护理机构的比例更高（26.3%对2.3%）（所有p<0.001）。误吸后的30天死亡率为20.7%，而未误吸患者为0.8%（p<0.001）。误吸独立增加了30天死亡率的风险（比值比3.1（95%可信区间2.2 - 4.5））。
大型泌尿外科手术后的术后误吸是一种毁灭性并发症，必须对高危患者群体采取预防措施以避免此类事件。
