围手术期肺部护理综合措施的实施对1665例癌症手术患者术后结局的影响：来自约旦一家三级转诊癌症中心的经验

The impact of a perioperative pulmonary care bundle implementation on postoperative outcomes in 1,665 surgical cancer patients: experience from a tertiary referral cancer center in Jordan.

作者信息

Abdel Jalil Riad, Al-Najjar Hani, Abou Chaar Mohamad K, Al-Masri Mahmoud, Daoud Faiez, Al-Ebous Ali, Dabous Ali, Shehadeh Ahmad M, Abdel Al Samer, Alawneh Fade, Al-Qudah Obada, Al-Kharabsheh Mohammad, Al-Odat Ghazi, Mohammad Iqbal, Hussein Najah, Hudaip Zeinab, Al-Tbakhi Asma, Aqel Flsteen

机构信息

Department of Surgery, King Hussein Cancer Center, Amman, Jordan.

Thoracic Surgery Unit, Lung Service Tumor Board, Surgical Residency Program, King Hussein Cancer Center, Amman, 1194, Jordan.

出版信息

Patient Saf Surg. 2021 Jan 6;15(1):5. doi: 10.1186/s13037-020-00277-z.

DOI:10.1186/s13037-020-00277-z

PMID:33407717

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7788896/

Abstract

BACKGROUND

Postoperative pulmonary complications can be a major catastrophic consequence of major surgeries and can lead to increased morbidity, mortality, hospital stay, and cost. Many protocols have been tried to reduce serious adverse outcomes with effective strategies including a bundle of preoperative, intraoperative and postoperative techniques. Using these techniques maybe challenging in developing countries with limited resources even in specialized centers.

METHODS

A before-and-after trial comparing our data from the national surgical quality improvement program (NSQIP) based on their reports. Data was collected prospectively for the patients who underwent major surgeries at King Hussein Cancer Center during the year 2017 when the use of the perioperative pulmonary care bundle was mandatory to all surgery teams and compared it with the data collected retrospectively for the patients who underwent the same type of surgeries in the year 2016 when the use of such a bundle was optional. The primary end point is the decrease in incidence of postoperative pulmonary complications. Simple descriptive statistical analysis was used to obtain results.

RESULTS

The potential risk factors for postoperative pulmonary complications for 1665 patients divided into 2 groups (2016 vs. 2017); 764 (45.9%) vs. 901 (54.1%), respectively. There were no significant differences regarding gender (male 46.7% vs. 46.4%, P value = 0.891, female 53.3% vs. 53.6%, P value = 0.39), mean of age (53.5 year vs. 5.28 year, P value = 0.296), mean of body mass index (BMI) (28.6 vs. 6%, 28.6, P value = 0.95), smoking status; (69.6% vs. 65.1%, P value = 0.052), ventilator use (0.3% vs. 0.4% P value = 0.693) and chronic obstructive pulmonary disease (1.4% vs. 1.4 with, P value = 0.996).The data showed a significant reduction in postoperative pneumonia between the 2 groups (2016 vs. 2017) (2.7% vs. 0.9%, P value = 0.004) and showed a significant reduction in unplanned intubation, 1.4% in 2016 vs. 0.7% in 2017.

CONCLUSIONS

The standardization of perioperative pulmonary care bundle, including smoking cessation, perioperative pulmonary interventions and early mobilization, significantly reduces the incidence of postoperative pulmonary complications in cancer patients. This technique's implementation was feasible easily even with limited resources in a developing country like Jordan.

摘要

背景

术后肺部并发症可能是大手术的一个主要灾难性后果，可导致发病率、死亡率、住院时间和费用增加。人们尝试了许多方案，通过包括一系列术前、术中和术后技术在内的有效策略来减少严重不良后果。即使在专业中心，在资源有限的发展中国家使用这些技术可能具有挑战性。

方法

一项前后对照试验，根据国家外科质量改进计划（NSQIP）的报告比较我们的数据。前瞻性收集2017年在侯赛因国王癌症中心接受大手术患者的数据，当时所有手术团队都必须使用围手术期肺部护理套餐，并将其与2016年接受相同类型手术患者的回顾性收集数据进行比较，当时使用该套餐是可选的。主要终点是术后肺部并发症发生率的降低。使用简单的描述性统计分析来获得结果。

结果

1665例患者分为两组（2016年与2017年）术后肺部并发症的潜在风险因素；分别为764例（45.9%）和901例（54.1%）。在性别方面无显著差异（男性46.7%对46.4%，P值 = 0.891，女性53.3%对53.6%，P值 = 0.39），年龄均值（53.5岁对52.8岁，P值 = 0.296），体重指数（BMI）均值（28.6对28.6，P值 = 0.95），吸烟状况（69.6%对65.1%，P值 = 0.052），呼吸机使用情况（0.3%对0.4%，P值 = 0.693）和慢性阻塞性肺疾病（1.4%对1.4%，P值 = 0.996）。数据显示两组（2016年与2017年）术后肺炎显著减少（2.7%对0.9%，P值 = 0.004），计划外插管也显著减少，2016年为1.4%，2017年为0.7%。