Central Hospital in Kristianstad, Kristianstad, Sweden.
Lund University, Lund, Sweden.
Acta Anaesthesiol Scand. 2020 Sep;64(8):1154-1161. doi: 10.1111/aas.13604. Epub 2020 Apr 28.
Long-term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long-term effects of surgical exposure prior to ICU admission.
Registry-based cohort study. The adjusted effect of surgical exposure for mortality was examined using Cox regression. Secondary analysis with conditional logistic regression in a case-control subpopulation matched for age, gender, and Simplified Acute Physiology Score III (SAPS3) was also conducted.
72 242 adult patients (56.9% males, median age 66 years [IQR 50-76]), admitted to Swedish ICUs in 3-year (2012-2014) were followed for a median of 2026 days (IQR 1745-2293). Cardiovascular diseases (17.5%), respiratory diseases (15.8%), trauma (11.2%), and infections (11.4%) were the leading causes for ICU admission. Mortality at longest follow-up was 49.4%. Age; SAPS3; admissions due to malignancies, respiratory, cardiovascular and renal diseases; and transfer to another ICU were associated with increased mortality. Surgical exposure prior to ICU admission (adjusted hazard ratio [aHR] 0.90; 95% CI 0.87-0.94; P < .001), admissions from the operation theatre (aHR 0.94; CI 0.90-0.99; P = .022) or post-anaesthesia care unit (aHR 0.92; CI 0.87-0.97; P = .003) were associated with decreased mortality. Conditional logistic regression confirmed the association between surgical exposure and decreased mortality (adjusted odds ratio 0.82; CI 0.75-0.91; P < .001).
Long-term ICU mortality was associated with known risk factors such as age and SAPS3. Transfer to other ICUs also appeared to be a risk factor and requires further investigation. Prior surgical exposure was associated with better outcomes, a noteworthy observation given limited ICU admissions after surgery in Sweden.
接受重症监护病房（ICU）治疗的患者的长期预后尚不清楚。我们研究了 ICU 入住前手术暴露对患者长期预后的影响。
基于注册的队列研究。采用 Cox 回归分析手术暴露对死亡率的调整影响。在年龄、性别和简化急性生理学评分 III（SAPS3）匹配的病例对照亚群中，也进行了条件逻辑回归的二次分析。
共纳入 72242 名成年患者（56.9%为男性，中位年龄为 66 岁[IQR 50-76]），这些患者于 2012-2014 年入住瑞典 ICU，中位随访时间为 2026 天（IQR 1745-2293）。心血管疾病（17.5%）、呼吸系统疾病（15.8%）、创伤（11.2%）和感染（11.4%）是导致 ICU 入住的主要原因。最长随访期间的死亡率为 49.4%。年龄、SAPS3、因恶性肿瘤、呼吸系统、心血管和肾脏疾病而入院以及转至另一家 ICU 与死亡率增加相关。ICU 入住前的手术暴露（调整后的危险比[aHR]0.90；95%CI 0.87-0.94；P<0.001）、从手术室（aHR 0.94；CI 0.90-0.99；P=0.022）或麻醉后护理病房（aHR 0.92；CI 0.87-0.97；P=0.003）转入与死亡率降低相关。条件逻辑回归证实了手术暴露与死亡率降低之间的关联（调整后的比值比[OR]0.82；CI 0.75-0.91；P<0.001）。
长期 ICU 死亡率与年龄和 SAPS3 等已知危险因素相关。转至其他 ICU 似乎也是一个危险因素，需要进一步研究。先前的手术暴露与更好的结果相关，这一观察结果值得注意，因为瑞典手术后 ICU 入住率有限。
