Gender-Based Analysis of Perioperative Outcomes Associated with Lower Extremity Bypass
Gender-Based Analysis of Perioperative Outcomes Associated with Lower Extremity Bypass
复制标题
下肢搭桥术相关围手术期结果的性别分析
DOI：
--
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
M. Corriere
中科院分区：
文献类型：
--
作者：
A. Jain;G. Velázquez;P. Goodney;M. Edwards;M. Corriere
我们分析了术前因素、手术特征和下肢旁路术后30天结局的性别差异。LEB手术是从美国外科医师学会国家外科质量改进计划参与者用户文件中确定的。采用卡方检验、t检验和非参数方法对术前和手术变量进行分组比较;采用logistic回归评估性别对死亡率、全身和手术部位并发症的影响。女性（4107/11011 [37.3%]）年龄较大，高血压、糖尿病、慢性阻塞性肺病、静息痛、透析、既往卒中、开放性/感染伤口和依赖性功能状态的患病率较高（所有比较P < 0.01）。女性更常接受急诊和解剖外手术，但静脉管道或胫骨水平流出使用率较低。确定了女性性别与30天死亡率、全身和手术部位并发症风险之间的单变量相关性;在多变量建模中，只有与手术部位并发症的相关性仍然显著（OR，1.8; 95%CI，1.6 - 2.1; P < 0.0001）。基于性别的人口统计学、合并症和手术因素的差异可能导致LEB相关围手术期结局的差异。女性可能与手术部位并发症的风险增加有关，但女性的30天死亡率和全身并发症发生率可能反映了混杂因素的影响，而不是性别特异性影响。
We analyzed gender-based differences in preoperative factors, procedural characteristics, and 30-day outcomes after lower extremity bypass (LEB). LEB procedures were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File. Groupwise comparisons of preoperative and procedural variables were made using chi square, t tests, and nonparametric methods; gender influences on mortality, systemic, and surgical site complications were evaluated using logistic regression. Women (4,107 of 11,011 [37.3%]) were older and had greater prevalence of hypertension, diabetes, chronic obstructive pulmonary disease, rest pain, dialysis, previous stroke, open/infected wound, and dependent functional status (P < 0.01 for all comparisons). Women more commonly underwent emergent and extra-anatomic procedures but had lower rates of venous conduit or tibial level outflow use. Univariable associations between female gender and risk of 30-day mortality, systemic, and surgical site complications were identified; only the association with surgical site complications remained significant in multivariable modeling (OR, 1.8; 95% CI, 1.6 to 2.1; P < 0.0001). Gender-based differences in demographic, comorbidity, and procedural factors may contribute to disparities in perioperative outcomes associated with LEB. Female gender may be associated with increased risk for surgical site complications, but 30-day mortality and systemic complication rates in women may reflect effects of confounding factors rather than gender-specific influence.