Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2020 Jul;110(1):128-135. doi: 10.1016/j.athoracsur.2019.09.100. Epub 2019 Nov 27.
This study evaluated the impact of postoperative complications on long-term survival after cardiac surgery.
Adults undergoing an index cardiac operation from January 2010 to December 2017 were included. Patients were stratified by the number and type of major complications as defined by The Society of Thoracic Surgeons. Failure to rescue was defined as mortality after a complication that occurred before hospital discharge. Long-term mortality among patients with complications was defined as a postcomplication death occurring after hospital discharge. Multivariable Cox regression was used for risk adjustment.
In all, 9532 patients were included in the study, and 16.8% (n = 1600) had a major postoperative complication. Operative mortality was 0.8% for patients with no complications. Early failure to rescue increased as the number of complications increased (7.5%, 28.1%, and 51.5% for one, two, and three or more complications, respectively; P < .0001). Median length of intensive care unit and hospital stay ranged, respectively, from 38 hours and 7 days for patients with no complications to 359 hours and 23 days for patients with three or more complications (P < .0001). The adverse impact of complications on survival persisted at 1-year follow-up (3.5%, 18.8%, 52.1%, and 77.9%; P < .0001) and 5-year follow-up (10.8%, 33%, 61.8%, and 77.9%; P < .0001) for patients with no complications or one, two, or three or more complications, respectively. Risk-adjusted analysis confirmed these findings (P < .0001). Furthermore, 5-year survival conditional on 30-day survival ranged from 85.1% to 41.5% for patients with no complications versus three or more complications (P < .0001).
Postoperative complications after cardiac surgery, particularly when occurring in combination, have a profound impact on long-term survival, even after excluding early postoperative deaths.
本研究评估了术后并发症对心脏手术后长期生存的影响。
纳入 2010 年 1 月至 2017 年 12 月期间接受指数心脏手术的成年人。根据胸外科医师学会定义的主要并发症的数量和类型对患者进行分层。失败抢救定义为并发症发生在出院前导致的死亡。并发症后患者的长期死亡率定义为出院后发生的并发症后死亡。多变量 Cox 回归用于风险调整。
共有 9532 例患者纳入研究，16.8%（n=1600）发生重大术后并发症。无并发症患者的手术死亡率为 0.8%。早期抢救失败率随着并发症数量的增加而增加（分别为无并发症、一、二和三或更多并发症患者的 7.5%、28.1%和 51.5%；P<0.0001）。无并发症患者的重症监护病房和住院时间中位数分别为 38 小时和 7 天，而三或更多并发症患者的中位数分别为 359 小时和 23 天（P<0.0001）。并发症对生存的不利影响在 1 年随访（3.5%、18.8%、52.1%和 77.9%；P<0.0001）和 5 年随访（10.8%、33%、61.8%和 77.9%；P<0.0001）时仍然存在，分别为无并发症或一、二或三或更多并发症的患者。风险调整分析证实了这些发现（P<0.0001）。此外，无并发症与三或更多并发症患者的 30 天生存条件下的 5 年生存率分别为 85.1%至 41.5%（P<0.0001）。
心脏手术后的术后并发症，特别是合并发生时，对长期生存有深远影响，甚至在排除术后早期死亡后也是如此。
