Lawrence V A, Hilsenbeck S G, Mulrow C D, Dhanda R, Sapp J, Page C P
Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX 78284, USA.
J Gen Intern Med. 1995 Dec;10(12):671-8. doi: 10.1007/BF02602761.
Internists frequently evaluate preoperative cardiopulmonary risk and co-manage cardiac and pulmonary complications, but the comparative incidence and clinical importance of these complications are not clearly delineated. This study evaluated incidence and length of stay for both cardiac and pulmonary complications after elective laparotomy.
Nested case-control.
University-affiliated Department of Veterans Affairs Hospital.
Computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991.
Strategy for ascertainment and verification of complications was systematic and explicit. The charts of all 116 patients identified by the registry as having complications and 412 (19%) randomly selected from 2,175 remaining patients were reviewed to verify presence or absence of cardiac or pulmonary complications, using explicit criteria and independent abstraction of pre- and postoperative components of charts. From these 528 validated cases and controls (23% of the cohort), 96 cases and 96 controls were matched by operation type and age within ten years. Hospital and intensive care unit stays were significantly longer (p < 0.0001) for the cases than for the controls (24.1 vs 10.3 and 5.6 vs 1.5 days, respectively). All 19 deaths occurred among the cases. Among the cases, pulmonary complications occurred significantly more often than cardiac complications (p < 0.00001) and were associated with significantly longer hospital stays (22.7 vs 10.4 days, p = 0.001). Combined cardiopulmonary complications occurred among 28% of the cases. Misclassification-corrected incidence rates for the entire cohort were 9.6% (95% CI 7.2-12.0) for pulmonary and 5.7% (95% CI 3.6-7.7) for cardiac complications.
For noncardiac surgery, previous research has focused on cardiac risk. In this study, pulmonary complications were more frequent, were associated with longer hospital stay, and occurred in combination with cardiac complications in a substantial proportion of cases. These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment.
内科医生经常评估术前心肺风险并共同处理心脏和肺部并发症，但这些并发症的相对发生率和临床重要性尚未明确界定。本研究评估了择期剖腹手术后心脏和肺部并发症的发生率及住院时间。
嵌套病例对照研究。
大学附属退伍军人事务医院。
1982年至1991年期间所有2291例行择期腹部手术患者的计算机登记资料。
并发症的确定和核实策略系统且明确。对登记系统确定的所有116例有并发症的患者以及从2175例其余患者中随机抽取的412例（19%）患者的病历进行审查，以使用明确标准并独立提取病历的术前和术后部分来核实是否存在心脏或肺部并发症。从这528例经过验证的病例和对照（占队列的23%）中，96例病例和96例对照按手术类型和年龄在十年内进行匹配。病例组的住院时间和重症监护病房住院时间显著长于对照组（分别为24.1天对10.3天以及5.6天对1.5天，p < 0.0001）。所有19例死亡均发生在病例组中。在病例组中，肺部并发症的发生频率显著高于心脏并发症（p < 0.00001），且与更长的住院时间相关（22.7天对10.4天，p = 0.001）。28%的病例发生了心肺联合并发症。整个队列经错误分类校正后的发生率为：肺部并发症9.6%（95%可信区间7.2 - 12.0），心脏并发症5.7%（95%可信区间3.6 - 7.7）。
对于非心脏手术，以往研究主要关注心脏风险。在本研究中，肺部并发症更常见，与更长的住院时间相关，且在相当比例的病例中与心脏并发症同时发生。这些结果表明，需要进一步研究以全面描述术后心脏和肺部并发症的临床流行病学，并更好地指导术前风险评估。
