Carr Zyad J, Yan Luying, Yanez N David, Schonberger Robert B, Bohorquez Manuel, He Zili, Li Fangyong, Hines Roberta L, Treggiari Miriam M
Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut.
Yale New Haven Hospital, New Haven, Connecticut.
Med Res Arch. 2023 Oct;11(10). doi: 10.18103/mra.v11i10.4606. Epub 2023 Oct 25.
Systemic sclerosis (SSc) is a rare autoimmune disorder with pathological manifestations affecting multiple organ systems. Few studies have examined perioperative outcomes in patients with this disorder. The primary aim of this retrospective single-center comparative cohort analysis was to estimate the incidence of select perioperative complications in a population of SSc patients. In an exploratory analysis, we analyzed the relationship between SSc and susceptibility to select perioperative complications when treated at a large quaternary-care institution.
We conducted a single-center retrospective, comparative cohort study to compare perioperative outcomes in a SSc (n=258) and a frequency matched control cohort (n=632). We analyzed for the presence of major composite infection (MCI), major adverse cardiac events (MACE), 30-day readmission, 30-day mortality, in-hospital complications, length of stay and airway management outcomes.
MCI was higher in the SSc compared to the control cohort [adjusted odds ratio (ORadj)=5.02 (95%CI: 2.47-10.20) p<0.001]. Surgical site infection (3.5% vs. 0%, p<0.001), and other infection types (5% vs. 0%, p<0.001) were higher in the SSc cohort. MACE was not significantly different between SSc vs. Control groups [6.2% vs. 7.9%, ORadj=1.33 (95%CI: 0.61-2.91) p=0.48]. Higher rates of limited cervical range of motion (13.6% vs. 3.5%, p<0.001), microstomia (11.5% vs. 1.3%, p<0.001) and preoperative difficult airway designation (8.7% vs. 0.5%, p<0.001) were observed in the SSc cohort. Bag mask ventilation grade was similar between groups (p=0.44). After adjustment, there was no between-group difference in Cormack-Lehane grade 3 and 4 view on direct laryngoscopy in SSc patients [ORadj = 1.86 (95%CI: 0.612 -5.66) p=0.18] but evidence of higher rates of video laryngoscopy [ORadj= 1.87 (95%CI:1.07 - 3.27) p=0.03]. Length of stay [median: 0.2 vs. 0.3 days, p=0.08], 30-day mortality [1.2% vs. 0.6%, ORadj=2.79 (95%CI: 0.50-15.6) p=0.24] and readmission [11.5% vs. 8.1%, ORadj=1.64 (95%CI: 0.96 - 2.82) p=0.07] were not statistically significant.
SSc patients demonstrate mostly similar rates of MACE, 30-day mortality, length of stay intraoperative and airway complications. There is evidence of increased risk of overall 30-day MCI risk and readmission after endoscopic procedures.
系统性硬化症（SSc）是一种罕见的自身免疫性疾病，其病理表现会影响多个器官系统。很少有研究探讨患有这种疾病的患者的围手术期结局。这项回顾性单中心比较队列分析的主要目的是估计一组系统性硬化症患者中特定围手术期并发症的发生率。在一项探索性分析中，我们分析了在一家大型四级医疗机构接受治疗时系统性硬化症与特定围手术期并发症易感性之间的关系。
我们进行了一项单中心回顾性比较队列研究，以比较系统性硬化症患者（n = 258）和频率匹配的对照组（n = 632）的围手术期结局。我们分析了是否存在严重复合感染（MCI）、主要不良心脏事件（MACE）、30天再入院、30天死亡率、住院并发症、住院时间和气道管理结局。
与对照组相比，系统性硬化症患者的MCI更高[调整后的优势比（ORadj）= 5.02（95%置信区间：2.47 - 10.20），p < 0.001]。系统性硬化症队列中的手术部位感染（3.5%对0%，p < 0.001）和其他感染类型（5%对0%，p < 0.001）更高。系统性硬化症组与对照组之间的MACE无显著差异[6.2%对7.9%，ORadj = 1.33（95%置信区间：0.61 - 2.91），p = 0.48]。在系统性硬化症队列中观察到颈椎活动范围受限率更高（13.6%对3.5%，p < 0.001）、小口症（11.5%对1.3%，p < 0.001）和术前困难气道判定率更高（8.7%对0.5%，p < 0.001）。两组之间的袋面罩通气分级相似（p = 0.44）。调整后，系统性硬化症患者直接喉镜检查时Cormack-Lehane 3级和4级视野的组间差异无统计学意义[ORadj = 1.86（95%置信区间：0.612 - 5.66），p = 0.18]，但有证据表明视频喉镜检查率更高[ORadj = 1.87（95%置信区间：1.07 - 3.27），p = 0.03]。住院时间[中位数：0.2天对0.3天，p = 0.08]、30天死亡率[1.2%对0.6%，ORadj = 2.79（95%置信区间：0.50 - 15.6），p = 0.24]和再入院率[11.5%对8.1%，ORadj = 1.64（95%置信区间：0.96 - 2.82），p = 0.07]无统计学意义。
系统性硬化症患者的主要不良心脏事件、30天死亡率、住院时间、术中及气道并发症发生率大多相似。有证据表明内镜手术后30天总体严重复合感染风险和再入院风险增加。
