Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Anesthesiology. 2023 Jun 1;138(6):602-610. doi: 10.1097/ALN.0000000000004558.
Surgery causes transient impairment in cognition and function, which may impact driving safety. The authors hypothesized that the risk of a motor vehicle crash would increase after compared to before surgery.
The authors performed a nested case-crossover study within population-based observational data from the New Jersey Safety Health Outcomes Data Warehouse. The study included adults 18 yr or older with a valid driver's license who underwent general surgery in an acute care hospital in New Jersey between January 1, 2016, and November 30, 2017, and were discharged home. Individuals served as their own controls within a presurgery interval (56 days to 28 days before surgery) and postsurgery interval (discharge through 28 days after surgery). General surgery was defined by Common Procedural Terminology Codes. The primary outcome was a police-reported motor vehicle crash.
In a cohort of 70,722 drivers, the number of crashes after surgery was 263 (0.37%) compared to 279 (0.39%) before surgery. Surgery was not associated with a change in crash incidence greater than 28 days using a case-crossover design (adjusted incidence rate ratio, 0.92; 95% CI, 0.78 to 1.09; P = 0.340). Statistical interaction was present for sex and hospital length of stay. Younger versus older adults (adjusted risk ratio, 1.87; 95% CI, 1.10 to 3.18; P = 0.021) and non-Hispanic Black individuals (adjusted risk ratio, 1.96; 95% CI, 1.33 to 2.88; P = 0.001) and Hispanic individuals (adjusted risk ratio, 1.38; 95% CI, 1.00 to 1.91; P = 0.047) versus non-Hispanic White individuals had a greater risk of a crash after surgery.
Using population-based crash and hospital discharge data, the incidence of motor vehicle crashes over a 28-day period did not change on average before compared to after surgery. The authors provide data on crash risk after surgery and highlight specific populations at risk.
手术会导致认知和功能的短暂障碍，这可能会影响驾驶安全。作者假设与手术前相比，手术后发生机动车事故的风险会增加。
作者在新泽西州安全健康结果数据仓库的基于人群的观察性数据中进行了嵌套病例对照研究。该研究纳入了 2016 年 1 月 1 日至 2017 年 11 月 30 日期间在新泽西州一家急性护理医院接受普通外科手术并出院回家的年龄在 18 岁及以上、持有有效驾照的成年人。个体在术前间隔（手术前 56 天至 28 天）和术后间隔（出院至术后 28 天）内作为自身对照。普通外科手术通过通用程序术语代码定义。主要结局是警方报告的机动车事故。
在 70722 名驾驶员的队列中，手术后发生的撞车事故数量为 263 起（0.37%），而手术前为 279 起（0.39%）。使用病例交叉设计，手术与 28 天以上的撞车发生率变化无关（调整后的发病率比，0.92；95%CI，0.78 至 1.09；P = 0.340）。性别和医院住院时间存在统计学交互作用。与年龄较大的成年人相比，年龄较小的成年人（调整后的风险比，1.87；95%CI，1.10 至 3.18；P = 0.021）和非西班牙裔黑人（调整后的风险比，1.96；95%CI，1.33 至 2.88；P = 0.001）和西班牙裔个体（调整后的风险比，1.38；95%CI，1.00 至 1.91；P = 0.047）发生手术后撞车的风险更高。
使用基于人群的撞车和医院出院数据，与手术前相比，手术后 28 天内机动车事故的发生率平均没有变化。作者提供了手术后撞车风险的数据，并强调了特定的风险人群。
