Department of Surgery, University of Texas Health San Antonio, San Antonio, TX.
South Texas Veterans Health Care System, San Antonio, TX.
Ann Surg. 2023 Feb 1;277(2):e294-e304. doi: 10.1097/SLA.0000000000005027. Epub 2023 Jan 10.
The aim of this study was to expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males.
Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1).
Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90-, and 180-day mortality.
OSS expansion resulted in 98.2% case coverage versus 87.0% using the original. Of 82,269 patients (43.8% male), 7.9% were frail/very frail. Males had higher odds of PASC [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) = 1.21-1.41, P < 0.001] and severe/life-threatening Clavien-Dindo IV (CDIV) complications (aOR = 1.18, 95% CI = 1.09-1.28, P < 0.001). Although mortality rates were higher (all time-points, P < 0.001) in males versus females, mortality was similar after adjusting for frailty, OSS, and case status primarily due to increased male frailty scores. Additional adjustments for PASC and CDIV resulted in a lower odds of mortality in males (30-day, aOR = 0.81, 95% CI = 0.71-0.92, P = 0.002) that was most pronounced for males with PASC compared to females with PASC (30-day, aOR = 0.75, 95% CI = 0.56-0.99, P = 0.04).
Similar to the male-dominated Veteran population, private sector, frail patients have high likelihood of postoperative mortality, even after low-stress surgeries. Preoperative frailty screening should be performed regardless of magnitude of the procedure. Despite males experiencing higher adjusted odds of PASC and CDIV complications, females with PASC had higher odds of mortality compared to males, suggesting differences in the aggressiveness of care provided to men and women.
本研究旨在扩大手术应激评分（OSS）的覆盖范围，并评估 OSS 与术前急性严重情况（PASC）、并发症和女性与男性死亡率之间的关系。
退伍军人事务部的一项以男性为主的研究表明，即使在应激程度很低的手术（OSS1）后，虚弱的退伍军人的死亡率也很高。
使用 NSQIP 数据（2013-2019 年）进行回顾性队列研究，并与多家医院的 180 天术后死亡率合并，以评估 PASC、30 天并发症以及 30、90 和 180 天死亡率。
OSS 扩展后，病例覆盖率达到 98.2%，而使用原始 OSS 则为 87.0%。在 82269 名患者中（43.8%为男性），有 7.9%为虚弱/非常虚弱。男性发生 PASC 的可能性更高[调整后的优势比（aOR）=1.31，95%置信区间（CI）=1.21-1.41，P<0.001]和严重/危及生命的 Clavien-Dindo IV（CDIV）并发症（aOR=1.18，95%CI=1.09-1.28，P<0.001）。尽管男性的死亡率在所有时间点均高于女性（均 P<0.001），但在调整了虚弱、OSS 和病例状态后，死亡率在男性和女性之间相似，这主要是由于男性虚弱评分增加所致。进一步调整 PASC 和 CDIV 后，男性的死亡率降低（30 天，aOR=0.81，95%CI=0.71-0.92，P=0.002），与女性相比，男性发生 PASC 的患者更为明显（30 天，aOR=0.75，95%CI=0.56-0.99，P=0.04）。
与以男性为主的退伍军人群体相似，私营部门的虚弱患者即使在接受低应激手术后，也有很高的术后死亡风险。无论手术规模如何，都应进行术前虚弱筛查。尽管男性发生 PASC 和 CDIV 并发症的调整后优势比更高，但与男性相比，发生 PASC 的女性的死亡率更高，这表明男性和女性接受的治疗力度存在差异。
