欧洲老年患者围手术期结局研究：一项 30 天前瞻性队列研究。
Peri-interventional outcome study in the elderly in Europe: A 30-day prospective cohort study.
出版信息
Eur J Anaesthesiol. 2022 Mar 1;39(3):198-209. doi: 10.1097/EJA.0000000000001639.
OBJECTIVES
The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality.
DESIGN
A prospective cohort study.
SETTING
European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period.
PATIENTS
Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia.
MAIN OUTCOME MEASURES
The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan-Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect.
RESULTS
Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days.
CONCLUSIONS
The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov.
目的
本研究旨在描述欧洲 80 岁及以上接受手术和非手术麻醉程序的患者的 30 天死亡率，并确定与死亡率相关的风险因素。
设计
前瞻性队列研究。
设置
欧洲多中心研究，于 2017 年 10 月至 2018 年 12 月进行。各中心承诺在研究期间内进行为期 30 天的招募。
患者
连续招募的 9497 名 80 岁及以上接受任何类型手术或非手术麻醉程序的患者。
主要观察指标
通过 Kaplan-Meier 曲线描述 30 天内全因死亡率，曲线下 95%置信区间。使用 Cox 回归模型分析 30 天死亡率的风险因素，模型包含 14 个固定效应和一个随机中心效应。
结果
对来自 20 个国家的 177 家学术和非学术医院的 9497 名患者的数据进行了分析（中位年龄 83.0 岁，52.8%为女性）。患者患有多种合并症（77%）、衰弱（14%）和至少部分功能依赖（38%）。估计的 30 天死亡率为 4.2%（95%置信区间 3.8%至 4.7%）。其他独立的 30 天死亡率风险因素包括多种合并症，风险比 1.87（95%置信区间 1.26 至 2.78）、衰弱，风险比 2.63（95%置信区间 2.10 至 3.30）和行动不便，风险比 2.19（95%置信区间 1.24 至 3.86）。大多数死亡（76%）发生在医院内。与计划内 ICU 入院相比，非计划内 ICU 入院的死亡风险更高，风险比为 3.57（95%置信区间 2.38 至 5.26），而计划内 ICU 入院的风险比为 1.92（95%置信区间 1.47 至 2.50）。与其他研究相比，出院后 17.4%和 3.9%的院内并发症发生率较低。在干预后 30 天内入住老年护理病房与前 10 天的更好生存相关。
结论
在这个脆弱的人群中，估计的 30 天死亡率为 4.2%，低于预期。
试验注册
ClinicalTrials.gov 标识符：NCT03152734，https://clinicaltrials.gov。
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