择期升主动脉手术后住院时间延长及相关危险因素。
Extended length of stay after elective ascending aortic surgery and associated risk factors.
作者信息
Ceylan Levent, Ozhan Abdulkerim, Bastopcu Murat, Erdogan Sevinc Bayer
机构信息
Department of Cardiovascular Surgery, Siyami Ersek Research and Training Hospital, Istanbul, Turkiye.
Department of Cardiovascular Surgery, Kutahya Health Sciences University, Evliya Celebi Training and Research Hospital, Kutahya, Turkiye.
出版信息
North Clin Istanb. 2022 Oct 24;9(5):445-450. doi: 10.14744/nci.2021.27037. eCollection 2022.
OBJECTIVE
Surgery on the ascending aorta incurs greater risk than other cardiac procedures. The primary aim of this study is to identify pre-operative and operative risk factors that play a role in extended length of stay (LOS) after elective surgery for ascending aortic aneurysms. The secondary aim is to determine post-operative outcomes associated with extended LOS.
METHODS
Patients who underwent elective surgery aged >18 between January 2018 and December 2019 for ascending aortic aneurysm with or without concomitant interventions in a single heart surgery center were retrospectively identified. Patients with days of hospital stay longer than the median length made up the extended stay group. The extended stay group was compared against the rest of the patients for demographics and operative parameters, as well as post-operative outcomes.
RESULTS
Patients with extended LOS were older (60.0±12.2 vs. 54.0±14.2, p=0.001) with more frequent coronary artery disease (CAD) (47.2% vs. 23.7%, p<0.001) and chronic obstructive pulmonary disease (COPD) (25.0% vs. 11.9% p=0.013). More patients in the extended LOS group required HCA for distal aortic anastomosis (43.5% vs. 17.5%, p<0.001) and cardiopulmonary bypass (CPB) durations were longer (283.1±83.9 vs. 225.3±84.2 min, p<0.001). Multivariate analysis revealed age, CAD, COPD, HCA, and CPB time as risk factors for extended LOS. Extended LOS patients had longer mechanical ventilation times (23.0±21.3 vs. 13.6±5.3 h, p<0.001), more frequently had acute renal failure (24.2% vs. 6.7%, p<0.001), reoperation for bleeding (20.7% vs. 6.7%, p=0.003), and stroke (14.3% vs. 4.3%, p=0.011).
CONCLUSION
In elective surgery for ascending aortic aneurysms older age, history of COPD and CAD, longer CPB times, and HCA during surgery are associated with extended LOS. Further studies are needed to investigate the association of prolonged hospital stay with long-term outcomes, as well as the impact of operation type on hospital stay.
目的
升主动脉手术比其他心脏手术风险更高。本研究的主要目的是确定在择期升主动脉瘤手术后住院时间延长（LOS）中起作用的术前和术中风险因素。次要目的是确定与住院时间延长相关的术后结局。
方法
回顾性确定2018年1月至2019年12月期间在单一心脏手术中心接受择期手术、年龄>18岁、患有或未伴有其他干预措施的升主动脉瘤患者。住院天数超过中位数的患者组成延长住院组。将延长住院组与其他患者在人口统计学和手术参数以及术后结局方面进行比较。
结果
住院时间延长的患者年龄更大（60.0±12.2岁 vs. 54.0±14.2岁，p=0.001），冠状动脉疾病（CAD）更常见（47.2% vs. 23.7%，p<0.001），慢性阻塞性肺疾病（COPD）更常见（25.0% vs. 11.9%，p=0.013）。延长住院组中更多患者在远端主动脉吻合时需要进行心脏停跳辅助（HCA）（43.5% vs. 17.5%，p<0.001），体外循环（CPB）时间更长（283.1±83.9分钟 vs. 225.3±84.2分钟，p<0.001）。多因素分析显示年龄、CAD、COPD、HCA和CPB时间是住院时间延长的风险因素。住院时间延长的患者机械通气时间更长（23.0±21.3小时 vs. 13.6±5.3小时，p<0.001），更频繁发生急性肾衰竭（24.2% vs. 6.7%，p<0.001）、因出血再次手术（20.7% vs. 6.7%，p=0.003）和中风（14.3% vs. 4.3%，p=0.011）。
结论
在择期升主动脉瘤手术中，年龄较大、有COPD和CAD病史、CPB时间较长以及术中进行HCA与住院时间延长相关。需要进一步研究以调查住院时间延长与长期结局的关联，以及手术类型对住院时间的影响。
Zotero 插件