Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, Bielefeld University Hospital, Campus Bielefeld-Bethel, University of Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
Coordination office for studies in biomedicine and preclinical and clinical research, Protestant Hospital of the Bethel Foundation, University Hospital OWL, University of Bielefeld, Maraweg 21, 33617 Bielefeld, Germany.
J Clin Anesth. 2021 Oct;73:110366. doi: 10.1016/j.jclinane.2021.110366. Epub 2021 Jun 1.
To determine 30-day-mortality, incidence and characteristics of perioperative cardiac arrest as well as the respective independent risk factors in preterm infants undergoing non-cardiac surgery.
Retrospective observational Follow-up-study.
Bielefeld University Hospital, a German tertiary care hospital.
Population of 229 preterm infants (age < 37th gestational week at the time of surgery) who underwent non-cardiac surgery between 01/2008-12/2018.
Primary endpoint was overall 30-day-mortality. Secondary endpoints were the incidence of perioperative cardiac arrest and identification of independent risk factors. We performed univariate and multivariate analyses and calculated odds ratios (OR) for risk factors associated with these endpoints.
30-day-mortality was 10.9% and perioperative mortality 0.9%. Univariate risk factors for 30-day-mortality were perioperative cardiac arrest (OR,12.5;95%CI,3.1 to 50.3), comorbidities of lungs (OR,3.7;95%CI,1.2 to 11.3) and gastrointestinal tract (OR,3.5;95%CI,1.3 to 9.6); sepsis (OR,3.6;95%CI,1.4 to 9.5); surgery between 22:01-7:00 (OR,7.3;95%CI,2.4 to 21.7); emergency (OR,4.5;95%CI,1.6 to 12.4); pre-existing catecholamine therapy (OR,5.0;95%CI,2.1 to 11.9). Multivariate logistic regression indicated that perioperative cardiac arrest (OR,13.9;95%CI,2.7 to 71.3), low body weight (weight < 1000 g: OR,26.0;95%CI,3.2 to 212; 1000-1499 g: OR,10.3; 95%CI,1.1 to 94.9 compared to weight > 2000 g), and time of surgery (OR,5.9;95%CI,1.6 to 21.3) for 22:01-7:00 compared to 7:01-15:00) were the major independent risk factors of mortality. Incidence of perioperative cardiac arrests was 3.9% (9 of 229;95%CI,1.8 to 7.3). Univariate risk factors were congenital anomalies of the airways (OR,4.7;95%CI,1.2 to 20.3), lungs (OR,4.7;95%CI,1.2 to 20.3) and heart (OR,8.0;95%CI,2 to 32.2), pre-existing catecholamine therapy (OR,59.5;95%CI,3.4 to 1039), specifically, continuous infusions of epinephrine (OR,432;95%CI,43.2 to 4318).
30-day-mortality and the incidence of perioperative cardiac arrest of preterms undergoing non-cardiac surgery were higher than previously reported. The identified independent risk factors may improve interdisciplinary perioperative risk assessment, optimal preoperative stabilization and scheduling of optimal surgical timing.
确定行非心脏手术的早产儿的 30 天死亡率、围术期心脏骤停的发生率和特征，以及各自的独立危险因素。
回顾性观察性随访研究。
德国三级护理医院比勒费尔德大学医院。
2008 年 1 月至 2018 年 12 月期间行非心脏手术的 229 名早产儿（手术时<37 孕周）。
主要终点为总 30 天死亡率。次要终点为围术期心脏骤停的发生率和识别独立危险因素。我们进行了单变量和多变量分析，并计算了与这些终点相关的危险因素的比值比（OR）。
30 天死亡率为 10.9%，围术期死亡率为 0.9%。30 天死亡率的单变量危险因素包括围术期心脏骤停（OR，12.5；95%CI，3.1 至 50.3）、肺（OR，3.7；95%CI，1.2 至 11.3）和胃肠道（OR，3.5；95%CI，1.3 至 9.6）合并症；败血症（OR，3.6；95%CI，1.4 至 9.5）；22:01 至 7:00 之间的手术（OR，7.3；95%CI，2.4 至 21.7）；急诊（OR，4.5；95%CI，1.6 至 12.4）；预先存在的儿茶酚胺治疗（OR，5.0；95%CI，2.1 至 11.9）。多变量逻辑回归表明，围术期心脏骤停（OR，13.9；95%CI，2.7 至 71.3）、低体重（体重<1000g：OR，26.0；95%CI，3.2 至 212；体重 1000-1499g：OR，10.3；95%CI，1.1 至 94.9 与体重>2000g 相比）和手术时间（OR，5.9；95%CI，1.6 至 21.3）与 22:01 至 7:00 相比，7:01 至 15:00）是死亡的主要独立危险因素。围术期心脏骤停的发生率为 3.9%（9/229；95%CI，1.8 至 7.3）。单变量危险因素为气道先天性异常（OR，4.7；95%CI，1.2 至 20.3）、肺（OR，4.7；95%CI，1.2 至 20.3）和心脏（OR，8.0；95%CI，2 至 32.2）、预先存在的儿茶酚胺治疗（OR，59.5；95%CI，3.4 至 1039），特别是肾上腺素的持续输注（OR，432；95%CI，43.2 至 4318）。
行非心脏手术的早产儿的 30 天死亡率和围术期心脏骤停的发生率高于以往报道。确定的独立危险因素可改善围手术期的多学科风险评估、最佳术前稳定化和最佳手术时机安排。
