Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Arch Bronconeumol. 2021 Oct;57(10):625-629. doi: 10.1016/j.arbr.2021.07.003. Epub 2021 Aug 12.
Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.
Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.
A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88).
Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.
术后失败救治（Failure to rescue，FTR）定义为术后发生并发症的患者的死亡率，被认为是手术护理质量的一个指标。本研究旨在探讨与解剖性肺切除术后 FTR 相关的危险因素。
本研究纳入了 1994 年至 2018 年在我中心接受解剖性肺切除术的患者。根据术后发病率的标准化分类，将术后并发症分为轻微（I 级和 II 级）和严重（IIIa 至 V 级）。在发生严重并发症后死亡的患者被视为 FTR。建立逐步逻辑回归模型以确定 FTR 的预测因素。多变量分析中包含的自变量包括年龄、体重指数、心脏、肾脏和脑血管合并症、ppoFEV1%、VATS 方法、扩大切除术、肺切除术和再次干预。构建非参数 ROC 曲线以估计模型的预测能力。
共纳入 2569 例患者，其中 223 例（8.9%）发生严重并发症，49 例（22%）无法救治。与 FTR 相关的变量包括：年龄（OR：1.07）、脑血管意外史（OR：3.53）、肺切除术（OR：6.67）和再次干预（OR：12.26）。ROC 曲线下面积为 0.82（95%CI：0.77-0.88）。
本系列中，22%接受解剖性肺切除术后发生严重并发症的患者在出院前未能存活。肺切除术和再次干预是 FTR 的最重要危险因素。
