School of Medicine, University of California San Diego, La Jolla, CA.
School of Medicine, University of California San Diego, La Jolla, CA.
J Cardiothorac Vasc Anesth. 2019 Sep;33(9):2465-2470. doi: 10.1053/j.jvca.2019.01.064. Epub 2019 Feb 8.
To examine risk factors associated with 30-day unplanned reintubation after pleurodesis.
A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program surgical outcomes registry.
United States hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.
The study comprised 2,358 patients who underwent video-assisted thorascopic surgery for pleurodesis from 2007 to 2016.
None.
The final sample included 2,358 cases, of which 93 (3.9%) required 30-day unplanned reintubation. Cases with 30-day unplanned reintubation, compared to those without, had higher unadjusted rates of American Society of Anesthesiologists physical status (ASA PS) score ≥4 (54.8% v 27.2%), preoperative dyspnea (71% v 57%), congestive heart failure (14% v 5.4%), functional dependence (28% v 10.3%), and diabetes mellitus (29% v 17.8%) (all p < 0.05). Patients with 30-day reintubation experienced higher unadjusted rates of 30-day outcomes including mortality (50.5% v 10.1%), pneumonia (28% v 4.9%), ventilator dependence (50.5% v 10.1%), sepsis (7.5% v 1.9%), myocardial infarction (5.4% v 0.1%), cardiac arrest (18.3% v 0.6%), transfusion (14% v 4.5%), and reoperation (15.1% v 3.2%) (all p < 0.05). The odds of 30-day unplanned reintubation were increased significantly on multivariable analysis for patients with ASA PS score ≥4, functional dependence, disseminated cancer, renal dialysis, and weight loss (all p < 0.05).
Given the dearth of population-based studies addressing risk factors of reintubation after pleurodesis, this study suggests further review of preoperative optimization, which is required to improve patient outcomes and safety.
探讨与胸腔粘连术后 30 天计划性再插管相关的危险因素。
使用美国外科医师学会国家外科质量改进计划手术结果登记处的回顾性队列研究。
美国参与美国外科医师学会国家外科质量改进计划的医院。
本研究纳入了 2007 年至 2016 年间因胸腔粘连行电视辅助胸腔镜手术的 2358 例患者。
无。
最终样本包括 2358 例患者，其中 93 例（3.9%）需要 30 天计划性再插管。与未再插管的病例相比，再插管的病例中，美国麻醉医师协会身体状况（ASA PS）评分≥4 的未调整比例更高（54.8%比 27.2%），术前呼吸困难（71%比 57%），充血性心力衰竭（14%比 5.4%），功能依赖（28%比 10.3%）和糖尿病（29%比 17.8%）（均 P<0.05）。再插管的患者 30 天结局的未调整比例更高，包括死亡率（50.5%比 10.1%），肺炎（28%比 4.9%），呼吸机依赖（50.5%比 10.1%），脓毒症（7.5%比 1.9%），心肌梗死（5.4%比 0.1%），心脏骤停（18.3%比 0.6%），输血（14%比 4.5%）和再次手术（15.1%比 3.2%）（均 P<0.05）。多变量分析显示，ASA PS 评分≥4、功能依赖、弥散性癌症、肾透析和体重减轻的患者 30 天计划性再插管的可能性显著增加（均 P<0.05）。
鉴于胸腔粘连术后再插管危险因素的人群研究较少，本研究建议进一步审查术前优化，这是改善患者结局和安全性所必需的。
