Identifying risk factors for potentially avoidable complications following radical cystectomy
Identifying risk factors for potentially avoidable complications following radical cystectomy
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DOI：
10.1097/01.ju.0000173923.35338.99
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发表时间：
2005-10-01
影响因子：
6.6
通讯作者：
Wei, JT
中科院分区：
文献类型：
--
作者：
Hollenbeck, BK;Miller, DC;Wei, JT
目的：根治性膀胱切除术后的发病率是常见的，并与卫生保健资源的使用增加有关。准确描述膀胱切除术后并发症、相关患者特定危险因素和围手术期护理过程对指导围手术期管理的改变至关重要，这将降低发病率，提高患者护理质量。材料和方法：国家外科质量改进计划（NSQIP）是全国123个退伍军人事务医疗中心的前瞻性质量管理倡议。NSQIP收集来自多个外科学科的各种外科手术的临床信息、术中数据和结果。自1991年以来，NSQIP记录了2538例根治性膀胱切除术。使用逻辑回归进行建模，以确定与术后发病率相关的患者特定危险因素和围手术期过程措施。结果：2538例患者中，774例（30.5%）出现至少1例术后并发症。最常见的并发症是肠梗阻（10%）。有几个因素与并发症的发生有关，包括年龄、依赖功能状态、术前呼吸困难、术前急性肾功能衰竭、慢性类固醇使用、术前饮酒、美国麻醉学会评分、全麻使用、手术时间、术中血液需求和外科医生培训水平。结论：膀胱切除术后的发病率仍然很高，30.5%的受试者出现至少一种并发症。可测量的患者特定危险因素和与膀胱切除术后术后发病率相关的围手术期过程现在被描述，这允许改进风险分层，患者咨询和开发可能逐步降低风险和改善结果的新过程。
Purpose: Morbidity after radical cystectomy is common and associated with increased health care resource use. Accurate characterization of complications after cystectomy, associated patient specific risk factors, and perioperative processes of care are essential to directing changes in perioperative management that will reduce morbidity and improve the quality of patient care.Materials and Methods: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. The NSQIP collects clinical information, intraoperative data and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomy procedures have been captured by the NSQIP. Modeling using logistic regression was performed to identify patient specific risk factors and perioperative process measures associated with postoperative morbidity.Results: Of the 2,538 subjects at least 1 postoperative complication developed in 774 (30.5%). The most frequent complication was ileus (10%). Several factors were associated with the development of a complication, including age, dependent functional status, preoperative dyspnea, preoperative acute renal failure, chronic steroid use, preoperative alcohol consumption, American Society of Anesthesiology score, use of general anesthetic, operative time, intraoperative blood requirement and surgeon level of training.Conclusions: Morbidity remains high after cystectomy with 30.5% of subjects experiencing at least 1 complication. Measurable patient specific risk factors and perioperative processes associated with postoperative morbidity following cystectomy are now delineated which allows for improved risk stratification, patient counseling, and the development of novel processes that may incrementally reduce risk and improve outcomes.