癌症患者择期腹部手术后主要并发症的预测因素。
Predictors of major complications after elective abdominal surgery in cancer patients.
作者信息
Simões Claudia M, Carmona Maria J C, Hajjar Ludhmila A, Vincent Jean-Louis, Landoni Giovanni, Belletti Alessandro, Vieira Joaquim E, de Almeida Juliano P, de Almeida Elisangela P, Ribeiro Ulysses, Kauling Ana L, Tutyia Celso, Tamaoki Lie, Fukushima Julia T, Auler José O C
机构信息
Anesthesia Department, Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil.
Anesthesia Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
出版信息
BMC Anesthesiol. 2018 May 9;18(1):49. doi: 10.1186/s12871-018-0516-6.
BACKGROUND
Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group.
METHODS
We performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events.
RESULTS
Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01-1.06], p = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33-5.17], p = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21-4.07], p = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03-4.07], p = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98-1.59], p = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00-4.31], p = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55-27.72], p = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75-0.84, p < 0.001).
CONCLUSIONS
Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids.
背景
接受腹部实体肿瘤手术的患者术后常发生严重并发症，这对生活质量、护理成本和生存率产生负面影响。很少有研究确定该组围手术期并发症的决定因素。
方法
我们进行了一项前瞻性观察性研究，纳入了2011年6月至2013年8月期间在单一机构接受腹部癌症手术的所有患者（年龄>18岁）。排除接受急诊手术、姑息性手术或参与其他研究的患者。主要结局是30天全因死亡率以及感染、心血管、呼吸、神经、肾脏和手术并发症的综合情况。进行单因素和多因素逻辑回归分析以确定围手术期主要不良事件的预测因素。
结果
在总共纳入的308例患者中，106例（34.4%）在30天随访期内发生了严重并发症。术后严重并发症的独立预测因素为：年龄（比值比[OR]1.03[95%置信区间1.01 - 1.06]，每年p = 0.012）、美国麻醉医师协会（ASA）身体状况大于或等于3（OR 2.61[95%置信区间1.33 - 5.17]，p = 0.003）、术前血红蛋白水平低于12 g/dL（OR 2.13[95%置信区间1.21 - 4.07]，p = 0.014）、术中使用胶体（OR 1.89，[95%置信区间1.03 - 4.07]，p = 0.047）、静脉输液总量（OR 1.22[95%置信区间0.98 - 1.59]，每升p = 0.106）术中失血大于500 mL（2.07[95%置信区间1.00 - 4.31]，p = 0.043）以及需要血管升压药支持的低血压（OR 4.68[95%置信区间1.55 - 27.72]，p = 0.004）。该模型具有良好的区分度，ROC曲线下面积为0.80（95%置信区间0.75 - 0.84，p < 0.001）。
结论
我们的研究结果表明，旨在降低癌症手术围手术期并发症的围手术期策略应包括治疗术前贫血和优化液体策略，避免液体过载和术中使用胶体。
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