Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia..
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.; Population Health Research Institute, Hamilton, Ontario, Canada..
Heart Lung. 2023 Mar-Apr;58:21-27. doi: 10.1016/j.hrtlng.2022.10.015. Epub 2022 Nov 4.
Some studies suggest that patients with pulmonary hypertension (PH) may be at higher risk of complications and death after noncardiac surgery. However, the magnitude of these associations is unclear.
To determine the associations between PH and adverse outcomes after noncardiac surgery.
We searched PUBMED and EMBASE for studies published from January 1970 to April 2022. We included studies that reported the association between PH and one or more outcomes of interest occurring after noncardiac surgery. Data were pooled using random-effects models and reported as summary odds ratios (ORs) with 95% confidence intervals (CIs).
Eighteen studies met eligibility criteria (n=18,214,760). PH was independently associated with mortality (adjusted odds ratio [OR] 2.09; 95% CI, 1.51-2.90; I=98%; 8 studies). PH was associated with a higher unadjusted risk of deep venous thrombosis (OR 4.02; 95% CI, 2.14-7.54; I=85%; 3 studies), pulmonary embolism (OR 4.16; 95% CI, 3.23-5.36; I=69%; 7 studies), myocardial infarction (OR 1.49; 95% CI, 1.44-1.54; I=0%; 5 studies), congestive heart failure or cardiogenic shock (OR 3.37; 95% CI, 1.73-6.60; I=34%; 5 studies), length of hospital stay (mean difference 1.97 days; 95% CI, 0.81-3.12; I=99%; 5 studies), and delayed extubation (OR 5.98; 95% CI, 1.70-21.02; I=3%; 3 studies). PH was associated with lower unadjusted risk of postoperative stroke (OR 0.93; 95% CI, 0.88-0.98; I=0%; 3 studies).
PH is a predictor of morbidity and mortality after noncardiac surgery. High quality studies are needed to determine effective strategies for reducing postoperative complications in this population.
一些研究表明，患有肺动脉高压（PH）的患者在非心脏手术后可能面临更高的并发症和死亡风险。然而，这些关联的程度尚不清楚。
确定 PH 与非心脏手术后不良结局之间的关联。
我们在 PUBMED 和 EMBASE 中检索了 1970 年 1 月至 2022 年 4 月发表的研究。我们纳入了报告 PH 与非心脏手术后发生的一个或多个感兴趣结局之间关联的研究。使用随机效应模型汇总数据，并以汇总优势比（OR）及其 95%置信区间（CI）报告。
18 项研究符合入选标准（n=18214760）。PH 与死亡率独立相关（调整后的 OR，2.09；95%CI，1.51-2.90；I=98%；8 项研究）。PH 与未经调整的深静脉血栓形成（OR，4.02；95%CI，2.14-7.54；I=85%；3 项研究）、肺栓塞（OR，4.16；95%CI，3.23-5.36；I=69%；7 项研究）、心肌梗死（OR，1.49；95%CI，1.44-1.54；I=0%；5 项研究）、充血性心力衰竭或心源性休克（OR，3.37；95%CI，1.73-6.60；I=34%；5 项研究）、住院时间延长（平均差异，1.97 天；95%CI，0.81-3.12；I=99%；5 项研究）和延迟拔管（OR，5.98；95%CI，1.70-21.02；I=3%；3 项研究）的风险增加相关。PH 与未经调整的术后中风风险降低相关（OR，0.93；95%CI，0.88-0.98；I=0%；3 项研究）。
PH 是预测非心脏手术后发病率和死亡率的指标。需要高质量的研究来确定降低该人群术后并发症的有效策略。
