Mullan Clancy W, Mori Makoto, Pichert Matthew D, Bin Mahmood Syed U, Yousef Sameh, Geirsson Arnar
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
J Card Surg. 2020 Sep;35(9):2248-2253. doi: 10.1111/jocs.14764. Epub 2020 Jul 17.
Comorbidity profiles of cardiac surgery patients are known to have changed over time, but modern national trends in these comorbidities and outcomes are not described. This study describes comorbidity trends over time for common adult cardiac surgery procedures.
A retrospective, cross-sectional analysis of the National Inpatient Sample was conducted for years 2005-2014. Hospitalizations with coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve repair/replacement (MVRR), as well as combined CABG/valve operations, were identified by ICD-9 procedure codes. Comorbidities were defined based on ICD-9 codes to discriminate between comorbidities and complications. Surgical volume, patient age, in-hospital mortality, and length of stay trends over time were evaluated by linear regression.
Incidence increased for AVR, MVRR, and CABG + AVR and declined for CABG and CABG + MVRR (P < .001). The mean number of comorbidities across all surgeries increased from 1.4 to 1.9 (P < .001). Length of stay declined for AVR, CABG + AVR, and CABG + MVRR (P < .001) with an overall decline from 10.1 to 9.7 days (P = .003). In-hospital mortality decreased in all categories over time (P < .001). Overall, in-hospital mortality decreased from 2.9% to 2.3% (P < .001).
Despite increasing comorbidity in cardiac surgery, operations are being conducted with fewer in-hospital mortalities across all types of surgery and decreasing length of stay for most types of surgery, which should inform the frequency of risk model updates and raise questions of the applicability of earlier studies in cardiac surgery to the modern population.
已知心脏手术患者的合并症情况随时间发生了变化，但这些合并症及预后的现代全国趋势尚无描述。本研究描述了常见成人心脏手术的合并症随时间的趋势。
对2005 - 2014年的国家住院样本进行回顾性横断面分析。通过ICD - 9手术编码识别接受冠状动脉旁路移植术（CABG）、主动脉瓣置换术（AVR）、二尖瓣修复/置换术（MVRR）以及CABG/瓣膜联合手术的住院病例。基于ICD - 9编码定义合并症，以区分合并症和并发症。通过线性回归评估手术量、患者年龄、住院死亡率及住院时间随时间的趋势。
AVR、MVRR和CABG + AVR的发病率增加，而CABG和CABG + MVRR的发病率下降（P <.001）。所有手术的合并症平均数量从1.4增加到1.9（P <.001）。AVR、CABG + AVR和CABG + MVRR的住院时间下降（P <.001），总体从10.1天降至9.7天（P =.003）。随着时间推移，所有类别中的住院死亡率均下降（P <.001）。总体而言，住院死亡率从2.9%降至2.3%（P <.001）。
尽管心脏手术中的合并症增多，但各类手术的住院死亡率降低，且大多数手术类型的住院时间缩短，这应为风险模型更新的频率提供依据，并引发关于早期心脏手术研究对现代人群适用性的问题。
