Hattler B G, Madia C, Johnson C, Armitage J M, Hardesty R L, Kormos R L, Pham S M, Payne D N, Griffith B P
Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pennsylvania 15213-2582.
Ann Thorac Surg. 1994 Nov;58(5):1348-52. doi: 10.1016/0003-4975(94)91911-9.
In an era of progressive cost containment and public scrutiny, the wisdom of aggressive surgical therapy for high-risk candidates has been questioned. At our center in the previous 24 months, 728 patients with coronary artery disease were entered into The Society of Thoracic Surgeons national database, and the hospital outcomes plus length of stay were analyzed. Patients were separated according to the predicted mortality based on the groupings in The Society of Thoracic Surgeons database: 0 to 5% (453 patients); 5% to 10% (126 patients); 10% to 20% (96 patients); 20% to 30% (17 patients); and 30% and greater (36 patients). There was a close correlation with the predicted rates of mortality. Importantly, the preoperative risk stratification demonstrated a strong correlation with the significant morbidity and excessive length of stay in the highest-risk groups (predicted risk of 20% to > or = 30%). The incidences of the most common complications in the group with the highest predicted risk (> or = 30%) were 28%, renal failure; 33%, ventilator dependence; and 17%, cardiac arrest. In addition, at short-term follow-up (6 to 8 months), a 24.3% mortality was identified in patients with a predicted mortality that exceeded 20%. These data quantify the risks and morbidities associated with the care of seriously ill patients with coronary artery disease and demonstrate the need for professional and public discussions focusing on the association of a high preoperative risk status and the consumption of resources.
在一个成本逐步得到控制且受到公众监督的时代，对于高风险患者采取积极手术治疗的合理性受到了质疑。在过去24个月里，我们中心有728例冠心病患者被纳入胸外科医师协会的全国数据库，并对住院结局及住院时间进行了分析。根据胸外科医师协会数据库中的分组，患者按预测死亡率进行了分类：0%至5%（453例患者）；5%至10%（126例患者）；10%至20%（96例患者）；20%至30%（17例患者）；以及30%及以上（36例患者）。这与预测的死亡率密切相关。重要的是，术前风险分层显示，在最高风险组（预测风险为20%至≥30%）中，与显著的发病率和过长的住院时间存在很强的相关性。预测风险最高组（≥30%）中最常见并发症的发生率分别为：肾衰竭28%；呼吸机依赖33%；心脏骤停17%。此外，在短期随访（6至8个月）中，预测死亡率超过20%的患者死亡率为24.3%。这些数据量化了与重症冠心病患者治疗相关的风险和发病率，并表明需要开展专业和公众讨论，重点关注术前高风险状态与资源消耗之间的关联。
