Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.
The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Interact Cardiovasc Thorac Surg. 2022 Jan 18;34(2):193-200. doi: 10.1093/icvts/ivab261.
Existing risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients' lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE).
The study included adults undergoing cardiac surgery in Denmark 2014-2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors.
Amongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17-1.51) and living alone (1.25; 1.14-1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00-1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70-0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes.
Social disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE.
105, 123.
现有的心脏外科风险预测模型基于预测风险对个体进行分层，其中仅包括医疗和生理因素。然而，风险评估的复杂性以及缺乏代表患者生活中非医疗方面的参数表明，心脏外科需要采用更广泛的模式。本研究旨在评估情绪和社会因素对 4 种结果的预测价值；心脏手术后 90 天内死亡、重症监护时间延长（≥72 小时）、住院时间延长（≥10 天）和 90 天内再入院，作为欧洲心脏手术风险评估系统（EuroSCORE）的传统风险评估的补充。
本研究纳入了 2014 年至 2017 年在丹麦接受心脏手术的成年人，包括基于登记的社会经济因素信息，以及嵌套子样本中的焦虑和抑郁症状的自我报告。对反映社会和情绪因素的变量进行了调整后的 EuroSCORE 的 logistic 回归分析。
在纳入的 7874 例患者中，调整 EuroSCORE 后，较低的教育水平（比值比 1.33；95%置信区间 1.17-1.51）和独居（1.25；1.14-1.38）与心脏手术后住院时间延长相关。较低的教育水平也与 ICU 入住时间延长相关（1.27；1.00-1.63）。高收入与延长住院时间的几率降低相关（0.78；0.70-0.87）。未发现焦虑或抑郁症状与任何结果之间存在关联或预测价值。
社会差异是心脏手术后不良结局的预测因素。焦虑和抑郁症状很常见，尤其是根据 EuroSCORE 具有高风险特征的患者。
105、123。
