Takada Kazuya, Nagamine Yusuke, Ishii Akira, Shuo Yan, Seike Takumi, Horikawa Hanako, Matsumiya Kentaro, Miyashita Tetsuya, Goto Takahisa
Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Kanagawa, Japan.
Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan.
Anesthesiol Res Pract. 2023 Aug 29;2023:8910198. doi: 10.1155/2023/8910198. eCollection 2023.
Early warning scores (EWSs) can be easily calculated from physiological indices; however, the extent to which intraoperative EWSs and the corresponding changes are associated with patient prognosis is unknown. In this study, we investigated whether EWS and the corresponding time-related changes are associated with patient outcomes during the anesthetic management of lower gastrointestinal perforation.
This was a single-center, retrospective cohort study conducted at a tertiary emergency care center. Adult patients who underwent surgery for spontaneous lower gastrointestinal perforations between September 1, 2012, and December 31, 2019, were included. The National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) were calculated based on the intraoperative physiological indices, and the associations with in-hospital death and length of hospital stay were investigated.
A total of 101 patients were analyzed. The median age was 70 years, and there were 11 cases of in-hospital death (mortality rate: 10.9%). There was a significant association between the intraoperative maximum NEWS and in-hospital death (odds ratio (OR): 1.60, 95% confidence interval (CI): 1.10-2.32, =0.013) and change from initial to maximum NEWS (OR: 1.60, 95% CI: 1.07-2.40, =0.023) in the crude analysis. However, when adjustments were made for confounding factors, no statistically significant associations were found. Other intraoperative EWS values and changes were not significantly associated with the investigated outcomes. The preoperative sepsis-related organ failure assessment score and the intraoperative base excess value were significantly associated with in-hospital death.
No clear association was observed between EWSs and corresponding changes and in-hospital death in cases of lower gastrointestinal perforation. The preoperative sepsis-related organ failure assessment score and intraoperative base excess value were significantly associated with in-hospital death.
早期预警评分（EWSs）可根据生理指标轻松计算得出；然而，术中早期预警评分及其相应变化与患者预后的关联程度尚不清楚。在本研究中，我们调查了在低位胃肠道穿孔麻醉管理期间，早期预警评分及其相应的时间相关变化是否与患者结局相关。
这是一项在三级急诊护理中心进行的单中心回顾性队列研究。纳入了2012年9月1日至2019年12月31日期间因自发性低位胃肠道穿孔接受手术的成年患者。根据术中生理指标计算国家早期预警评分（NEWS）和改良早期预警评分（MEWS），并研究其与院内死亡和住院时间的关联。
共分析了101例患者。中位年龄为70岁，院内死亡11例（死亡率：10.9%）。在粗分析中，术中最高NEWS与院内死亡之间存在显著关联（优势比（OR）：1.60，95%置信区间（CI）：1.10 - 2.32，P = 0.013），以及初始NEWS至最高NEWS的变化（OR：1.60，95% CI：1.07 - 2.40，P = 0.023）。然而，在对混杂因素进行调整后，未发现统计学上的显著关联。其他术中早期预警评分值及其变化与所研究的结局无显著关联。术前脓毒症相关器官功能衰竭评估评分和术中碱剩余值与院内死亡显著相关。
在低位胃肠道穿孔病例中，未观察到早期预警评分及其相应变化与院内死亡之间存在明确关联。术前脓毒症相关器官功能衰竭评估评分和术中碱剩余值与院内死亡显著相关。
