Atladottir Hjördis Osk, Modrau Ivy Susanne, Jakobsen Carl-Johan, Torp-Pedersen Christian Tobias, Gissel Marie Storebjerg, Nielsen Dorthe Viemose
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
J Thorac Cardiovasc Surg. 2021 Nov;162(5):1568-1577. doi: 10.1016/j.jtcvs.2020.03.005. Epub 2020 Mar 19.
To describe the associations among preoperative characteristics, intraoperative and postoperative factors, and mortality and morbidity after open-heart surgery in patients age ≥80 years.
This retrospective multicenter register study was based on prospectively collected data of all patients age ≥80 years undergoing open-heart surgery in western Denmark between 1999 and 2016. Logistic regression was used to estimate the associations among preoperative characteristics, intraoperative and postoperative factors, and morbidity and mortality. Bonferroni correction was used for multiple comparisons.
The study population included 2342 patients age ≥80 years undergoing open-heart surgery. We observed an association between severely impaired preoperative renal function and death within 1-year postsurgery (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-7.2). Furthermore, renal clearance <40 mL/min and prolonged cardiopulmonary bypass time of >180 minutes were associated with a >50% probability of death within 1 year. The adjusted OR for death within 1 year was increased significantly with a postoperative length of stay in intensive care of ≥3 days (OR, 5.9; 95% CI, 4.1-8.6) and a duration of postoperative mechanical ventilation ≥2 days (OR, 7.5; 95% CI, 4.1-13.9). Various preoperative and intraoperative characteristics were associated with in-hospital dialysis, in particular cardiopulmonary bypass time >180 minutes (OR, 11.6; 95% CI, 4.7-28.5).
Our findings emphasize the importance of careful referral regarding the procedural burden for very elderly patients and may provide support for informed patient discussions about prognosis and recovery.
描述80岁及以上患者心脏直视手术后术前特征、术中和术后因素与死亡率和发病率之间的关联。
这项回顾性多中心登记研究基于1999年至2016年在丹麦西部接受心脏直视手术的所有80岁及以上患者的前瞻性收集数据。采用逻辑回归来估计术前特征、术中和术后因素与发病率和死亡率之间的关联。采用Bonferroni校正进行多重比较。
研究人群包括2342例80岁及以上接受心脏直视手术的患者。我们观察到术前肾功能严重受损与术后1年内死亡之间存在关联（优势比[OR]，4.6；95%置信区间[CI]，2.7 - 7.2）。此外，肾清除率<40 mL/分钟和体外循环时间延长>180分钟与1年内死亡概率>50%相关。术后在重症监护病房住院时间≥3天（OR，5.9；95% CI，4.1 - 8.6）和术后机械通气时间≥2天（OR，7.5；95% CI，4.1 - 13.9），1年内死亡的校正OR显著增加。各种术前和术中特征与院内透析相关，尤其是体外循环时间>180分钟（OR，11.6；95% CI，4.7 - 28.5）。
我们的研究结果强调了对于高龄患者谨慎转诊以考虑手术负担的重要性，并可能为患者关于预后和恢复的知情讨论提供支持。
