Gómez Hernández M A Teresa, Novoa Valentín Nuria, Fuentes Gago Marta, Aranda Alcaide José Luis, Varela Simó Gonzalo, Jiménez López Marcelo F
Departamento de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España.
Departamento de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España.
Arch Bronconeumol (Engl Ed). 2020 May 31. doi: 10.1016/j.arbres.2020.04.015.
Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.
Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.
A total of 2,569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88).
Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.
未能挽救（FTR）被定义为术后并发症患者的死亡率，被视为外科护理质量的一个指标。本研究的目的是调查解剖性肺切除术后与FTR相关的危险因素。
纳入1994年至2018年在本中心接受解剖性肺切除的患者。根据术后发病率的标准化分类，术后并发症分为轻微（I级和II级）和严重（IIIA至V级）。发生严重并发症后死亡的患者被视为FTR。建立逐步逻辑回归模型以识别FTR预测因素。多变量分析中纳入的自变量包括年龄、体重指数、心脏、肾脏和脑血管合并症、ppoFEV1%、电视辅助胸腔镜手术（VATS）入路、扩大切除、肺切除术和再次干预。构建非参数ROC曲线以估计模型的预测能力。
共纳入2569例患者，其中223例（8.9%）发生严重并发症，49例（22%）未能挽救。与FTR相关的变量为：年龄（比值比：1.07）、脑血管意外史（比值比：3.53）、肺切除术（比值比：6.67）和再次干预（比值比：12.26）。ROC曲线下面积为0.82（95%置信区间：0.77 - 0.88）。
总体而言，本系列解剖性肺切除术后发生严重并发症的患者中有22%未存活至出院。肺切除术和再次干预是FTR最重要的危险因素。
