术后重症监护病房收治不会影响严重合并症择期手术患者的结局。
Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity.
机构信息
Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan.
Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan.
出版信息
Med Intensiva (Engl Ed). 2020 May;44(4):216-225. doi: 10.1016/j.medin.2019.01.003. Epub 2019 Feb 21.
OBJECTIVE
The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities.
DESIGN
A retrospective cohort study was carried out.
SETTING
University hospital.
PATIENTS
Surgical patients with severe comorbidities.
INTERVENTION
The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i.e., no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls.
VARIABLES OF INTEREST
Poor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90.
RESULTS
No significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs. 28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p=0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs. 2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs. 3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p=0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10kg (0.70-0.97), p=0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p=0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001].
CONCLUSIONS
Postoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries.
目的
通过回顾患有严重合并症的各种择期手术患者的不良结局发生率，评估术后重症监护对患者结局的影响。
设计
回顾性队列研究。
地点
大学医院。
患者
患有严重合并症的手术患者。
干预措施
对入住重症监护病房（ICU）和术后病房的 1218 名手术患者（ICU 组与非 ICU 组）的不良结局（即无出院或死亡）进行回顾性分析。采用倾向评分分析生成 248 对 ICU 入住患者和对照。
感兴趣的变量
术后第 90 天的不良结局发生率和术后第 30 天和第 90 天的死亡率。
结果
术后第 90 天，两组间不良结局发生率无显著差异[ICU 组 vs. 非 ICU 组：33/248（13%）vs. 28/248（11%）；ICU 比值比（OR）：1.19，95%置信区间（CI）0.71-2.01，p=0.596]；术后第 30 天和第 90 天，两组间死亡率也无显著差异[ICU 组 vs. 非 ICU 组：术后第 30 天 4/248（1.6%）vs. 2/248（0.8%），术后第 90 天 5/248（2.0%）vs. 3/248（1.2%）；ICU OR（95%CI），术后 30 天和 90 天死亡率分别为 2.00（0.37-10.9）和 1.67（0.40-6.97）（p=0.683 和 0.724）]。低术前体重与患者结局呈负相关[OR（95%CI）：0.82/10kg（0.70-0.97），p=0.019]，而区域镇痛联合全身麻醉与患者结局呈正相关[OR（95%CI）：0.39（0.69-0.96），p=0.006]。额外的 ICU 入住与患者不良结局相关[OR（95%CI）：4.18（2.23-7.81），p < 0.0001]。
结论
对于接受各种择期手术的患有严重合并症的患者，术后 ICU 入住并未显示出任何有意义的益处。
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