Banco Darcy, Dodson John A, Berger Jeffrey S, Smilowitz Nathaniel R
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA.
Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, New York, USA.
J Am Geriatr Soc. 2021 Oct;69(10):2821-2830. doi: 10.1111/jgs.17320. Epub 2021 Jun 27.
Older adults undergoing noncardiac surgery have a high risk of major adverse cardiovascular events (MACE). This study aims to estimate the magnitude of increased perioperative risk, and examine national trends in perioperative MACE following in-hospital noncardiac surgery in older adults compared to middle-aged adults.
Time-series analysis of retrospective longitudinal data.
The United States Agency for Healthcare Research and Quality National Inpatient Sample (NIS).
Hospitalizations for major noncardiac surgery among adults age ≥45 years between January 2004 and December 2014.
Inpatient perioperative MACE was defined as a composite of in-hospital death, myocardial infarction (MI), and ischemic stroke. In hospital death was determined from the NIS discharge disposition. MI and ischemic stroke were defined by International Classification of Diseases, Ninth Revision codes.
Of an estimated 55,349,978 surgical hospitalizations, 26,423,039 (47.7%) were for adults age 45-64, 14,231,386 (25.7%) age 65-74, 10,621,029 (19.2%) age 75-84 years, and 4,074,523 (7.4%) age ≥85 years. MACE occurred in 1,601,022 surgical hospitalizations (2.9%). Adults 65-74 (2.8%; aOR 1.16, 95% CI 1.14-1.17), 75-84 years (4.5%; aOR 1.30, 95% CI 1.28-1.32), and ≥85 years (6.9%; aOR 1.55, 95% CI 1.52-1.57) had greater risk of MACE than those 45-64 years (1.7%). From 2004 to 2014, MACE declined among adults 65-74 (3.1-2.5%, p < 0.001), 75-85 years (4.9-3.9%, p < 0.001), and ≥85 years (7.7-6.1%, p < 0.001), but was unchanged for adults age 45-64. Declines in MACE were driven by decreased MI and mortality despite increased stroke.
Older adults accounted for half of hospitalizations, but experienced the majority of MACE. Older adults had greater adjusted odds of MACE than younger individuals. The proportion of perioperative MACE declined over time, despite increases in ischemic stroke. These data highlight risks of noncardiac surgery in older adults that warrant increased attention to improve perioperative outcomes.
接受非心脏手术的老年人发生重大心血管不良事件（MACE）的风险很高。本研究旨在评估围手术期风险增加的程度，并比较老年人与中年成年人在住院接受非心脏手术后围手术期MACE的全国趋势。
回顾性纵向数据的时间序列分析。
美国医疗保健研究与质量局国家住院患者样本（NIS）。
2004年1月至2014年12月期间年龄≥45岁的成年人因重大非心脏手术而住院的患者。
住院围手术期MACE定义为住院死亡、心肌梗死（MI）和缺血性中风的综合指标。住院死亡由NIS出院处置确定。MI和缺血性中风由国际疾病分类第九版编码定义。
在估计的55349978例外科住院患者中，26423039例（47.7%）为45 - 64岁的成年人，14231386例（25.7%）为65 - 74岁，10621029例（19.2%）为75 - 84岁，4074523例（7.4%）年龄≥85岁。1601022例外科住院患者（2.9%）发生了MACE。65 - 74岁的成年人（2.8%；调整后比值比[aOR]1.16，95%置信区间[CI]1.14 - 1.17）、75 - 84岁的成年人（4.5%；aOR 1.30，95% CI 1.28 - 1.32）和≥85岁的成年人（6.9%；aOR 1.55，95% CI 1.52 - 1.57）发生MACE的风险高于45 - 64岁的成年人（1.7%）。从2004年到2（此处原文可能有误，推测为2014年），65 - 74岁的成年人中MACE有所下降（3.1% - 2.5%，p < 0.001），75 - 85岁的成年人中MACE有所下降（4.9% - 3.9%，p < 0.001），≥85岁的成年人中MACE也有所下降（7.7% - 6.1%，p < 0.001），但45 - 64岁的成年人中MACE没有变化。尽管中风增加，但MI和死亡率下降推动了MACE的下降。
老年人占住院患者的一半，但经历了大多数的MACE。老年人发生MACE的调整后几率高于年轻人。尽管缺血性中风有所增加，但围手术期MACE的比例随时间下降。这些数据突出了老年人非心脏手术的风险，值得更多关注以改善围手术期结局。
