Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
J Card Surg. 2021 Jun;36(6):2045-2052. doi: 10.1111/jocs.15471. Epub 2021 Mar 9.
The impact of postoperative complications on long-term survival is not well characterized. We sought to study the prevalence of postoperative complications after cardiac surgery and their impact on long-term survival.
Operative survivors (n = 26,221) who underwent coronary artery bypass grafting (CABG) (n = 13,054, 49.8%), valve surgery (n = 8667, 33.1%) or combined CABG and valve surgery (n = 4500, 17.2%) from 1993 to 2019 were included in the study. Records were reviewed for postoperative complications and long-term survival. Propensity-match analysis was performed between patients who did and did not have a postoperative complication. The associations between postoperative complications and survival were assessed using a Cox-proportional model.
Complications occurred in 17,463 (66.6%) of 26,221 operative survivors. A total of 17 postoperative complications were analyzed. Postoperative blood product use was the commonest (n = 12,397, 47.3%), followed by atrial fibrillation (n = 8399, 32.0%), prolonged ventilation (n = 2336, 8.9%), renal failure (n = 870, 3.3%), reoperation for bleeding (n = 859, 3.3%) and pacemaker/ICD insertion (n = 795, 3.0%). Stroke (hazard ratio [HR]: 1.55; 95% confidence interval [CI]: 1.36-1.77), renal failure (HR: 1.45; 95% CI: 1.33-1.58) and pneumonia (HR: 1.23; 95% CI: 1.11-1.36) had the strongest impact on long-term survival. Long-term survival decreased as the number of postoperative complications increased.
Postoperative complications after cardiac surgery significantly impact outcomes that extend beyond the postoperative period. Stroke, renal failure, and pneumonia are particularly associated with poor long-term survival.
术后并发症对长期生存的影响尚不清楚。我们旨在研究心脏手术后术后并发症的发生率及其对长期生存的影响。
纳入 1993 年至 2019 年间接受冠状动脉旁路移植术（CABG）（n=13054，49.8%）、瓣膜手术（n=8667，33.1%）或 CABG 联合瓣膜手术（n=4500，17.2%）的手术存活者（n=26221）。对术后并发症和长期生存进行记录复查。对发生和未发生术后并发症的患者进行倾向评分匹配分析。采用 Cox 比例风险模型评估术后并发症与生存的关系。
26221 例手术存活者中，17463 例（66.6%）发生并发症。共分析了 17 种术后并发症。术后血制品使用最为常见（n=12397，47.3%），其次为心房颤动（n=8399，32.0%）、延长通气（n=2336，8.9%）、肾衰竭（n=870，3.3%）、因出血再次手术（n=859，3.3%）和起搏器/ICD 植入（n=795，3.0%）。脑卒中（风险比 [HR]：1.55；95%置信区间 [CI]：1.36-1.77）、肾衰竭（HR：1.45；95% CI：1.33-1.58）和肺炎（HR：1.23；95% CI：1.11-1.36）对长期生存的影响最大。随着术后并发症数量的增加，长期生存率降低。
心脏手术后的术后并发症显著影响术后的生存结果。脑卒中、肾衰竭和肺炎与不良长期生存特别相关。
