Velanovich V
Department of Surgery, Madigan Army Medical Center, Tacoma, WA.
J R Coll Surg Edinb. 1993 Aug;38(4):225-30.
The purpose of this study was to identify factors from simple past medical history which could alert surgeons to patients at increased risk of postoperative complications. Five hundred and fourteen patients undergoing elective surgery were studied prospectively. Factors evaluated included the patients' age, gender, race and the presence in the past medical history of coronary artery disease, congestive heart failure, cardiac dysrhythmias, respiratory disease, endocrine disease, peripheral atherosclerosis, renal disease, neuropsychiatric disease, hypertension, diabetes mellitus, prior major surgery and prior or active malignancy. All complications were recorded. The data were analysed by univariate and multivariate statistical methods. Gender, race and age were not associated with any complications. Coronary artery disease, respiratory disease, atherosclerotic peripheral vascular disease, neuropsychiatric disease, malignancy, the absence of prior major surgery, hypertension and diabetes mellitus were associated with specific postoperative complications by univariate analysis. Malignancy, diabetes mellitus, peripheral atherosclerosis, coronary artery disease, neuropsychiatric disease, renal disease and respiratory disease were independent predictors of complications as determined by multivariate analysis. Of interest is the phenomenon that the risk of postoperative complications when a combination of risk factors was present was greater than what would be predicted by the cumulative risk of these factors. This study helps identify those patients which by simple history may be at increased risk of postoperative complications and may require aggressive preoperative evaluation.
本研究的目的是从既往病史中识别出能使外科医生警惕术后并发症风险增加的患者的因素。对514例接受择期手术的患者进行了前瞻性研究。评估的因素包括患者的年龄、性别、种族以及既往病史中是否存在冠状动脉疾病、充血性心力衰竭、心律失常、呼吸系统疾病、内分泌疾病、外周动脉粥样硬化、肾脏疾病、神经精神疾病、高血压、糖尿病、既往大手术史以及既往或现患恶性肿瘤。记录所有并发症。采用单因素和多因素统计方法对数据进行分析。性别、种族和年龄与任何并发症均无关联。单因素分析显示，冠状动脉疾病、呼吸系统疾病、外周动脉粥样硬化性血管疾病、神经精神疾病、恶性肿瘤、无既往大手术史、高血压和糖尿病与特定的术后并发症相关。多因素分析确定，恶性肿瘤、糖尿病、外周动脉粥样硬化、冠状动脉疾病、神经精神疾病、肾脏疾病和呼吸系统疾病是并发症的独立预测因素。有趣的是，当存在多种危险因素时，术后并发症的风险大于这些因素累积风险所预测的风险。本研究有助于识别那些通过简单病史可能术后并发症风险增加且可能需要积极术前评估的患者。
