美国麻醉医师学会（ASA）分类对髋部骨折手术结果的影响：来自回顾性分析的见解。
Impact of the American Society of Anesthesiologists (ASA) classification on hip fracture surgery outcomes: insights from a retrospective analysis.
机构信息
Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, 21163, Jordan.
Faculty of Medicine, Yarmouk University, Irbid, 21163, Jordan.
出版信息
BMC Anesthesiol. 2024 Aug 5;24(1):271. doi: 10.1186/s12871-024-02660-0.
BACKGROUND
The American Society of Anesthesiologists (ASA) classification is the most used system to assess patient health status before surgery, ranging from I to V levels. This study aims to explore the impact of different ASA risk classes (ASA II [mild risk] and ASA III [severe risk]) on clinical outcomes following hip fracture surgery, including all-cause mortality and postoperative complications.
METHODS
A retrospective analysis from 2019 to 2021 across three Jordanian centers was conducted. The study included patients aged 65 and above who underwent hip fracture repair surgeries. Preoperative measures, intraoperative management protocols, and postoperative care were collected. Clinical data were extracted from electronic medical records, including demographics, fracture type, intraoperative data, and postoperative outcomes.
RESULTS
The analysis included 1033 patients, with 501 (48.5%) in the mild anesthetic risk group (ASA I-II) and 532 (51.5%) in the severe anesthetic risk group (ASA III-V). The mean age was 73 years, with a higher prevalence of males in the severe risk group. Patients in the severe risk group had more comorbidities, higher ICU admissions (15.23% vs. 6.18%), longer hospital stays (median 7 vs. 6 days), and higher rates of postoperative thromboembolic complications (3.39% vs. 1.39%) compared to the mild risk group. Additionally, the severe risk group showed higher mortality rates both in-hospital mortality (3.38% vs. 1.39%) and all-cause mortality (16.92% vs. 10.36%). Multivariate analysis identified higher ASA score as independent risk factors for increased all-cause mortality (HR = 1.64 95%CI 1.51-2.34) and thromboembolic complications (OR = 2.85 95%CI 1.16-7). Length of hospital stay was significantly associated with higher ASA score (OR = 1.04 95%CI 0.96-1.11).
CONCLUSION
The study underscores the significant impact of anesthetic risk on the outcomes of hip fracture surgeries. Patients with higher ASA scores associated with severe systemic diseases may have at increased risk of adverse outcomes.
背景
美国麻醉师协会（ASA）分类是评估手术前患者健康状况最常用的系统，范围从 I 级到 V 级。本研究旨在探讨不同 ASA 风险类别（ASA II[轻度风险]和 ASA III[重度风险]）对髋部骨折手术后临床结果的影响，包括全因死亡率和术后并发症。
方法
对 2019 年至 2021 年在三个约旦中心进行的回顾性分析。研究纳入了年龄在 65 岁及以上接受髋部骨折修复手术的患者。收集了术前措施、术中管理方案和术后护理的临床数据。从电子病历中提取临床数据，包括人口统计学、骨折类型、术中数据和术后结果。
结果
该分析共纳入 1033 例患者，其中 501 例（48.5%）为轻度麻醉风险组（ASA I-II），532 例（51.5%）为重度麻醉风险组（ASA III-V）。平均年龄为 73 岁，重度风险组男性比例较高。与轻度风险组相比，重度风险组患者的合并症更多，ICU 入院率更高（15.23% vs. 6.18%），住院时间更长（中位数为 7 天 vs. 6 天），术后血栓栓塞并发症发生率更高（3.39% vs. 1.39%）。此外，重度风险组的院内死亡率（3.38% vs. 1.39%）和全因死亡率（16.92% vs. 10.36%）均较高。多变量分析确定较高的 ASA 评分是全因死亡率增加的独立危险因素（HR=1.64 95%CI 1.51-2.34）和血栓栓塞并发症（OR=2.85 95%CI 1.16-7）。住院时间与较高的 ASA 评分显著相关（OR=1.04 95%CI 0.96-1.11）。
结论
本研究强调了麻醉风险对髋部骨折手术结果的重大影响。伴有严重系统性疾病的 ASA 评分较高的患者可能有更高的不良结局风险。
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