Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY; Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY.
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Am Heart J. 2023 Jun;260:26-33. doi: 10.1016/j.ahj.2023.02.008. Epub 2023 Feb 16.
Perioperative bleeding is a common and potentially life-threatening complication after surgery. We sought to identify the frequency, patient characteristics, causes, and outcomes of perioperative bleeding in patients undergoing noncardiac surgery.
In a retrospective cohort study of a large administrative database, adults aged ≥45 years hospitalized for noncardiac surgery in 2018 were identified. Perioperative bleeding was defined using ICD-10 diagnosis and procedure codes. Clinical characteristics, in-hospital outcomes, and first hospital readmission within 6 months were assessed by perioperative bleeding status.
We identified 2,298,757 individuals undergoing noncardiac surgery, among which 35,429 (1.54%) had perioperative bleeding. Patients with bleeding were older, less likely to be female, and more likely to have renal and cardiovascular disease. All-cause, in-hospital mortality was higher in patients with vs without perioperative bleeding (6.0% vs 1.3%; adjusted OR [aOR] 2.38, 95% CI 2.26-2.50). Patients with vs without bleeding had a prolonged inpatient length of stay (6 [IQR 3-13] vs 3 [IQR 2-6] days, P < .001). Among those who were discharged alive, hospital readmission was more common within 6 months among patients with bleeding (36.0% vs 23.6%; adjusted HR 1.21, 95% CI 1.18-1.24). The risk of in-hospital death or readmission was greater in patients with vs without bleeding (39.8% vs 24.5%; aOR 1.33, 95% CI 1.29-1.38). When stratified by revised cardiac risk index , there was a stepwise increase in surgical bleeding risk with increasing perioperative cardiovascular risks.
Perioperative bleeding is reported in 1 out of every 65 noncardiac surgeries, with a higher incidence in patients at elevated cardiovascular risk. Among postsurgical inpatients with perioperative bleeding, approximately 1 of every 3 patients died during hospitalization or were readmitted within 6-months. Strategies to reduce perioperative bleeding are warranted to improve outcomes following non-cardiac surgery.
围手术期出血是手术后常见且潜在危及生命的并发症。我们旨在确定非心脏手术患者围手术期出血的频率、患者特征、原因和结局。
在一项回顾性队列研究中，我们从一个大型行政数据库中确定了 2018 年住院接受非心脏手术的年龄≥45 岁的成年人。使用 ICD-10 诊断和手术代码定义围手术期出血。根据围手术期出血情况评估临床特征、住院结局和 6 个月内首次院内再入院情况。
我们确定了 2298757 名接受非心脏手术的患者，其中 35429 名（1.54%）发生围手术期出血。出血患者年龄较大，女性比例较低，且更易患有肾脏和心血管疾病。与无围手术期出血的患者相比，有围手术期出血的患者全因、院内死亡率更高（6.0% vs 1.3%；调整后 OR [aOR] 2.38，95% CI 2.26-2.50）。与无出血的患者相比，有出血的患者住院时间延长（6 [IQR 3-13] vs 3 [IQR 2-6] 天，P<.001）。在存活出院的患者中，有出血的患者在 6 个月内再次入院更为常见（36.0% vs 23.6%；调整后 HR 1.21，95% CI 1.18-1.24）。与无出血的患者相比，有出血的患者院内死亡或再入院的风险更高（39.8% vs 24.5%；aOR 1.33，95% CI 1.29-1.38）。当按修订后的心脏风险指数分层时，随着围手术期心血管风险的增加，手术出血风险呈逐步增加趋势。
每 65 例非心脏手术中就有 1 例报告围手术期出血，心血管风险较高的患者发生率更高。在围手术期出血的术后住院患者中，约每 3 例患者中有 1 例在住院期间死亡或在 6 个月内再次入院。需要采取策略减少围手术期出血，以改善非心脏手术后的结局。
