影响65岁及以上患者心脏直视手术住院时间和住院费用的围手术期危险因素。

Perioperative risk factors affecting hospital stay and hospital costs in open heart surgery for patients > or = 65 years old.

作者信息

Fernandez J, Chen C, Anolik G, Brdlik O B, Laub G W, Anderson W A, McGrath L B

机构信息

Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015, USA.

出版信息

Eur J Cardiothorac Surg. 1997 Jun;11(6):1133-40. doi: 10.1016/s1010-7940(97)01216-5.

DOI:10.1016/s1010-7940(97)01216-5

PMID:9237599

Abstract

OBJECTIVE

Demographic changes, associated with increased demands for open heart surgery in the elderly, place increased burden on financial resources. To evaluate perioperative risk factors affecting incidence of hospital events and estimation of hospital charges, 2577 patients > or = 65 years (range 65-91), operated on from January 1991 to December 1994, were compared with a concurrent cohort of 2642 younger patients.

METHODS

Statistical analysis, by surgical procedure, focused on hospital mortality, key postoperative complications affecting length of hospital stay and hospital charges.

RESULTS

Overall hospital mortality was 4.7%, 3.5% in younger patients versus 6.1% in the older group (P << 0.01). Mortality was significantly lower in patients less than 65 years undergoing coronary artery bypass grafting (3% versus 5%, P < 0.01) and valve replacement (4% versus 9%, P = 0.01). Significant risk factors for hospital death in the elderly: diabetes (P < 0.01), hypertension (P < 0.01), myocardial infarction (P < 0.01) and congestive heart failure (P < 0.01). Significant postoperative events, more common in older patients, included prolonged ventilation (P << 0.01), congestive heart failure (P << 0.01), infection (P << 0.01), cerebrovascular accident (P < 0.01), and intra aortic balloon pump (P < 0.01). Incremental risk factors for morbidity in the elderly were: higher New York Heart Association class, congestive heart failure, emergent operation, and female gender. Mean length of hospital stay for the < 65 group was 15.3 versus > 19.5 days for the > 65 group (P << 0.01). Length of stay over 18 days positively correlated with increased morbidity in both age groups. For patients > or = 65 years of age, the average hospital charge for open heart surgery was 172% higher for patients with a length of stay greater than 18 days compared with 165% for patients less than 65 years of age.

CONCLUSIONS

Higher operative mortality and longer length of stay in elderly patients, resulting in increased health care costs, was associated with more co-morbidities. These results suggest interventions designed to reduce congestive heart failure and other co-morbidities may improve patient's recovery and reduce costs.

摘要

目的

人口结构变化导致老年人对心脏直视手术的需求增加，给财政资源带来了更大负担。为评估影响医院事件发生率的围手术期危险因素及估计医院费用，对1991年1月至1994年12月期间接受手术的2577例年龄≥65岁（年龄范围65 - 91岁）患者与同期2642例较年轻患者组成的队列进行了比较。

方法

按手术方式进行统计分析，重点关注医院死亡率、影响住院时间和医院费用的关键术后并发症。

结果

总体医院死亡率为4.7%，较年轻患者为3.5%，老年组为6.1%（P << 0.01）。年龄小于65岁接受冠状动脉旁路移植术的患者死亡率显著较低（3%对5%，P < 0.01），瓣膜置换术患者死亡率也较低（4%对9%，P = 0.01）。老年人医院死亡的显著危险因素：糖尿病（P < 0.01）、高血压（P < 0.01）、心肌梗死（P < 0.01）和充血性心力衰竭（P < 0.01）。显著的术后事件在老年患者中更常见，包括通气时间延长（P << 0.01）、充血性心力衰竭（P << 0.01）、感染（P << 0.01）、脑血管意外（P < 0.01）和主动脉内球囊反搏（P < 0.01）。老年人发病的增量危险因素为：纽约心脏协会心功能分级较高、充血性心力衰竭、急诊手术和女性。年龄<65岁组的平均住院时间为15.3天，年龄>65岁组为>19.5天（P << 0.01）。两个年龄组住院时间超过18天均与发病率增加呈正相关。对于年龄≥65岁的患者，住院时间超过18天的心脏直视手术患者平均医院费用比年龄小于65岁的患者高172%，而年龄小于65岁患者为165%。