The effect of comorbid illness on mortality outcomes in cardiac surgery
The effect of comorbid illness on mortality outcomes in cardiac surgery
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DOI：
10.1001/archsurg.137.4.428
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发表时间：
2002-04-01
影响因子：
--
通讯作者：
O'Connor, GT
中科院分区：
文献类型：
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作者：
Clough, RA;Leavitt, BJ;O'Connor, GT
假设：合并疾病与冠状动脉搭桥术的死亡风险相关。设计：收集关于患者和疾病特征以及包括高血压、糖尿病、肥胖、血管疾病、慢性阻塞性肺疾病、癌症(不包括非黑色素瘤皮肤癌)、依赖透析的肾功能衰竭、肝病和痴呆症的前瞻性队列研究数据。统计分析采用Logistic回归来计算调整后的优势比(OR)和95%可信区间(CI)。设置：区域心脏外科数据库。患者：共27239例连续接受单独冠状动脉搭桥术的患者。主要观察指标：住院死亡率。结果：合并疾病的发生率如下：高血压，64.3%；糖尿病，30.1%；肥胖，24.6%；严重肥胖，7.2%；血管疾病，18.3%；慢性阻塞性肺疾病，10.9%；消化性溃疡，7.5%；癌症，3.8%；肾功能衰竭，1.5%；肝病，0.6%；痴呆症，0.1%。在调整了患者和疾病特征，包括年龄、性别、既往心脏手术、手术优先顺序、左主干狭窄程度、病变冠状动脉数目和左心室射血分数后，下列并存情况是住院死亡率的显著预测因素：糖尿病(OR，1.19；95%CI 1.01-1.40；P=.03)、血管疾病(OR，1.67；95%CI，1.41-1.97；P
Hypothesis: Comorbid conditions are associated with the risk of death from coronary artery bypass graft surgery.Design: Prospective cohort study data were collected on patient and disease characteristics and comorbid conditions including hypertension, diabetes, obesity, vascular disease, chronic obstructive pulmonary disease, cancer (excluding nonmelanoma skin cancer), dialysis-dependent renal failure, liver disease, and dementia. Statistical analysis used logistic regression for the calculation of adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Setting: Regional cardiac surgery database.Patients: A total of 27239 consecutive patients undergoing isolated coronary artery bypass graft surgery.Main Outcome Measure: In-hospital mortality rate.Results: The prevalence of comorbid conditions was as follows: hypertension, 64.3%; diabetes, 30.1%; obesity, 24.6%; severe obesity, 7.2%; vascular disease, 18.3%; chronic obstructive pulmonary disease, 10-9%; peptic ulcer, 7.5%; cancer, 3.8%; renal failure, 1.5%; liver disease, 0.6%; and dementia, 0.1%. After adjustment for patient and disease characteristics, including age, sex, previous cardiac surgery, priority of surgery, degree of left main coronary stenosis, number of diseased coronary arteries, and left ventricular ejection fraction, the following comorbid conditions were significant predictors of in-hospital mortality: diabetes (OR, 1.19; 95% CI 1.01-1.40; P=.03), vascular disease (OR, 1.67; 95% CI, 1.41-1.97; P