Fu Hong, Zheng Jiang, Lai Jingyi, Xia Victor W, He Kaiping, Du Dingyuan
Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.
Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, USA.
Heliyon. 2023 Jan 21;9(2):e13117. doi: 10.1016/j.heliyon.2023.e13117. eCollection 2023 Feb.
We aimed to identify preoperative and intraoperative factors associated with serious postoperative outcomes, which may help patients and clinicians make better-informed decisions.
We conducted a retrospective study including all patients aged ≥90 years who underwent surgery between January 1, 2011, and January 1, 2021, at Chongqing University Central Hospital. We assessed 30 pre- and intraoperative demographic and clinical variables. Logistic regression was used to identify the independent risk factors for serious postoperative outcomes in patients aged ≥90 years.
A total of 428 patients were included in our analysis. The mean age was 92.6 years (SD ± 2.6). There were 240 (56.1%) females and 188 (43.9%) males. The most common comorbidities were hypertension (44.9%) and arrhythmias (34.8%). The 30-day hospital mortality was 5.6%, and severe morbidity was 33.2%. Based on the multivariate logistic regression classification analysis of the American Society of Anesthesiologists (ASA)≥ Ⅳ [odds ratio (OR), 5.39, 95% confidence interval (CI), 2.06-14.16, P = .001], emergency surgery (OR, 5.02, 95% CI, 2.85-15.98, P = .001) and chronic heart failure (OR, 6.11, 95% CI, 1.93-13.06, P = .001) were identified as independent risk factors for 30-day hospital mortality, and ASA≥ Ⅳ (OR, 4.56, 95%CI, 2.56-8.15, P < .001), Barthel index (BI) < 35 (OR, 2.28, 95%CI, 1.30-3.98, P = .001), chronic heart failure (OR, 3.67, 95%CI, 1.62-8.31, P = .002), chronic kidney disease (OR, 4.24, 95%CI, 1.99-9.05, P < .001), general anesthesia (OR, 3.31, 95%CI, 1.91-5.76, P < .001), emergency surgery (OR, 3.72, 95%CI, 1.98-6.99, P < .001), and major surgery (OR, 3.44, 95%CI, 1.90-6.22, P < .001) were identified as independent risk factors for serious postoperative complications.
Patients aged ≥90 years with ASA≥ Ⅳ, BI < 35, combined with chronic heart failure or chronic kidney disease, undergoing emergency surgery, major surgery or general anesthesia have a higher risk of serious postoperative outcomes. Identifying these risk factors in an early stage may contribute to our clinical decision-making and improve the quality of treatments.
我们旨在确定与严重术后结局相关的术前和术中因素，这可能有助于患者和临床医生做出更明智的决策。
我们进行了一项回顾性研究，纳入了2011年1月1日至2021年1月1日期间在重庆大学附属中心医院接受手术的所有年龄≥90岁的患者。我们评估了30项术前和术中的人口统计学和临床变量。采用逻辑回归分析确定年龄≥90岁患者严重术后结局的独立危险因素。
我们的分析共纳入428例患者。平均年龄为92.6岁（标准差±2.6）。女性240例（56.1%），男性188例（43.9%）。最常见的合并症是高血压（44.9%）和心律失常（34.8%）。30天住院死亡率为5.6%，严重并发症发生率为33.2%。基于美国麻醉医师协会（ASA）≥Ⅳ级的多因素逻辑回归分类分析[比值比（OR），5.39，95%置信区间（CI），2.06 - 14.16，P = 0.001]、急诊手术（OR，5.02，95%CI，2.85 - 15.98，P = 0.001）和慢性心力衰竭（OR，6.11，95%CI，1.93 - 13.06，P = 0.001）被确定为30天住院死亡率的独立危险因素，而ASA≥Ⅳ级（OR，4.56，95%CI，2.56 - 8.15，P < 0.001）、Barthel指数（BI）< 35（OR，2.28，95%CI，1.30 - 3.98，P = 0.001）、慢性心力衰竭（OR，3.67，95%CI，1.62 - 8.31，P = 0.002）、慢性肾脏病（OR，4.24，95%CI，1.99 - 9.05，P < 0.001）、全身麻醉（OR，3.31，95%CI，1.91 - 5.76，P < 0.001）、急诊手术（OR，3.72，95%CI，1.98 - 6.99，P < 0.001）和大手术（OR，3.44，95%CI，1.90 - 6.22，P < 0.001）被确定为严重术后并发症的独立危险因素。
年龄≥90岁、ASA≥Ⅳ级、BI < 35，合并慢性心力衰竭或慢性肾脏病，接受急诊手术、大手术或全身麻醉的患者术后发生严重结局的风险较高。早期识别这些危险因素可能有助于我们的临床决策并提高治疗质量。
