Cromhout Pernille F, Thygesen Lau C, Moons Philip, Nashef Samer, Damgaard Sune, Christensen Anne V, Rasmussen Trine B, Borregaard Britt, Thrysoee Lars, Thorup Charlotte B, Mols Rikke E, Juel Knud, Berg Selina K
Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.
The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
J Card Surg. 2021 Feb;36(2):509-521. doi: 10.1111/jocs.15227. Epub 2020 Dec 1.
The risk of poor outcomes is traditionally attributed to biological and physiological processes in cardiac surgery. However, evidence exists that other factors, such as emotional, behavioral, social, and functional, are predictive of poor outcomes. Objectives were to evaluate the predictive value of several emotional, social, functional, and behavioral factors on four outcomes: death within 90 days, prolonged stay in intensive care, prolonged hospital admission, and readmission within 90 days following cardiac surgery.
This prospective study included adults undergoing cardiac surgery 2013-2014, including information on register-based socioeconomic factors and self-reported health in a nested subsample. Logistic regression analyses to determine the association and incremental value of each candidate predictor variable were conducted. Multiple regression analyses were used to determine the incremental value of each candidate predictor variable, as well as discrimination and calibration based on the area under the curve (AUC) and Brier score.
Of 3217 patients, 3% died, 9% had prolonged intensive care stay, 51% had prolonged hospital admission, and 39% were readmitted to hospital. Patients living alone (odds ratio, 1.19; 95% confidence interval, 1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low health-related quality of life (1.43; 1.02-2.01) had prolonged hospital admission. Analyses revealed living alone as predictive of prolonged intensive care unit (ICU) stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71), and prolonged hospital admission (0.24; 0.62).
Living alone was found to supplement EuroSCORE in predicting death, prolonged hospital admission, and prolonged ICU stay following cardiac surgery. Low educational level and impaired health-related quality of life were, furthermore, predictive of prolonged hospital admission.
传统上认为心脏手术不良结局的风险归因于生物学和生理过程。然而，有证据表明，其他因素，如情绪、行为、社会和功能因素，也可预测不良结局。本研究旨在评估多种情绪、社会、功能和行为因素对心脏手术后90天内死亡、重症监护时间延长、住院时间延长以及90天内再次入院这四种结局的预测价值。
这项前瞻性研究纳入了2013 - 2014年接受心脏手术的成年人，在一个嵌套子样本中收集了基于登记的社会经济因素和自我报告健康状况的信息。进行逻辑回归分析以确定每个候选预测变量的关联和增量价值。使用多元回归分析来确定每个候选预测变量的增量价值，以及基于曲线下面积（AUC）和Brier评分的区分度和校准度。
在3217例患者中，3%死亡，9%的患者重症监护时间延长，51%的患者住院时间延长，39%的患者再次入院。独居患者（比值比，1.19；95%置信区间，1.02 - 1.38）、教育水平较低（1.27；1.04 - 1.54）以及健康相关生活质量较低（1.43；1.02 - 2.01）的患者住院时间延长。分析显示，独居可预测重症监护病房（ICU）住院时间延长（Brier评分，0.08；AUC，0.68）、死亡（0.03；0.71）和住院时间延长（0.24；0.62）。
研究发现，独居在预测心脏手术后的死亡、住院时间延长和ICU住院时间延长方面可补充欧洲心脏手术风险评估系统（EuroSCORE）。此外，教育水平低和健康相关生活质量受损可预测住院时间延长。
