Dhippayom Teerapon, Dilokthornsakul Piyameth, Laophokhin Vayroj, Kitikannakorn Nantawarn, Chaiyakunapruk Nathorn
Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
Department of Pharmacy Practice, Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
J Card Surg. 2020 Oct;35(10):2618-2626. doi: 10.1111/jocs.14855. Epub 2020 Aug 2.
Evidence on the burden of postsurgical complications is mainly from studies in western countries, and little is highlighted in the Asia-Oceania region. This study aimed to identify and compare the burden of postsurgical complications in major cardiac surgeries in Asia-Oceania countries.
A systematic search was performed in PubMed, Embase, and CENTRAL between January 2000 and July 2018. Inclusion criteria were: (a) observational studies or randomized control trials; (b) studied in coronary artery bypass graft (CABG) and/or heart valve procedures; (c) measured postsurgical clinical outcomes; and (d) conducted in Asia-Oceania countries. Pooled effects were calculated using a random-effects model.
Of the 6032 articles screened, 472 studies with a total of 614 161 patients met the inclusion criteria. The pooled incidences (95% confidence interval) of hospital mortality and 30-day mortality were similar at 2.38% (2.16%-2.59%) and 2.33% (2.16%-2.50%), respectively. Length of stay (LOS) was 14.07 days (13.44-14.71 days). The incidence for atrial fibrillation (AF) and stroke/cerebrovascular accident (CVA) was 17.49% (15.99%-18.99%) and 1.64% (1.51%-1.78%), respectively. Below outcomes tended to be better in studies on CABG compared to heart valve procedures, including the incidence of hospital mortality (1.97%[1.75%-2.18%] vs 3.97% [3.29%-4.65%]), AF (16.47% [14.85%-18.10%] vs 21.98% [17.41%-26.54%]), stoke/CVA (1.51% [1n 37%-1.65%] vs 2.55% [2.07%-3.04%]), and mean LOS (days) (13.08 [12.51-13.65] vs 19.58 [16.72-22.45]). Similarly, all postsurgical complications tended to be higher in studies involving high-risk patients vs non-high-risk patients.
There are opportunities to improve clinical outcomes of patients with high surgical risks and those undertaking heart valve procedures, as they tend to have poorer survival and higher risk in developing postsurgical complications.
关于术后并发症负担的证据主要来自西方国家的研究，而在亚太地区鲜有突出报道。本研究旨在确定并比较亚太地区国家主要心脏手术的术后并发症负担。
于2000年1月至2018年7月在PubMed、Embase和CENTRAL数据库中进行系统检索。纳入标准为：（a）观察性研究或随机对照试验；（b）研究冠状动脉搭桥术（CABG）和/或心脏瓣膜手术；（c）测量术后临床结局；（d）在亚太地区国家开展。采用随机效应模型计算合并效应。
在筛选的6032篇文章中，472项研究共纳入614161例患者，符合纳入标准。医院死亡率和30天死亡率的合并发生率（95%置信区间）相似，分别为2.38%（2.16%-2.59%）和2.33%（2.16%-2.50%）。住院时间（LOS）为14.07天（13.44-14.71天）。房颤（AF）和卒中/脑血管意外（CVA）的发生率分别为17.49%（15.99%-18.99%）和1.64%（1.51%-1.78%）。与心脏瓣膜手术相比，CABG研究中的以下结局往往更好，包括医院死亡率（1.97%[1.75%-2.18%]对3.97%[3.29%-4.65%]）、AF（16.47%[14.85%-18.10%]对21.98%[17.41%-26.54%]）、卒中/CVA（1.51%[1.37%-1.65%]对2.55%[2.07%-3.04%]）以及平均LOS（天）（13.08[12.51-13.65]对19.58[16.72-22.45]）。同样，与非高危患者相比，涉及高危患者的研究中所有术后并发症往往更高。
对于手术风险高的患者和接受心脏瓣膜手术的患者，有机会改善其临床结局，因为他们的生存往往较差，术后发生并发症的风险更高。
