Survival after postoperative morbidity: a longitudinal observational cohort study.
Survival after postoperative morbidity: a longitudinal observational cohort study.
复制标题
DOI：
10.1093/bja/aeu224
复制
发表时间：
2014-12
影响因子：
9.8
通讯作者：
Grocott MP
中科院分区：
文献类型：
--
作者：
Moonesinghe SR;Harris S;Mythen MG;Rowan KM;Haddad FS;Emberton M;Grocott MP
先前的研究表明，术后并发症可能会造成长期伤害。然而，由于需要进行风险调整和术后发病率的定义不一致，因此存在不确定性。我们对接受大手术的患者进行了一项纵向观察性队列研究。应用病例组合调整，并使用经验证的结局指标记录发病率。使用时间依赖性协变量的考克斯比例风险模型用于测量术后长期发病率和长期生存率之间的独立关系。分析了1362例患者的数据。平均住院时间为9天，平均随访时间为6.5年。与围手术期风险无关，术后神经系统疾病发病率（患病率2.9%）与长期死亡率2.00的相对风险相关[P=0.001; 95%置信区间（CI）1.32-3.04]。术后发病率延长（患病率15.6%），术后前12个月死亡的相对危险度为3.51（P<0.001; 95%CI 2.28-5.42），随后2年为2.44（P<0.001; 95%CI 1.62-3.65），此后恢复至基线水平。手术后长期发病与过早死亡的风险有关，其持续时间可能比通常认为的要长;然而，这种风险随着时间的推移而福尔斯。我们认为，以这种方式测量的长期术后发病率可能是外科医疗质量的有效指标。我们的研究结果加强了旨在减少术后并发症的持续时间和严重程度的研究和质量改进措施的重要性。
Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. We did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival. Data were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32–3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28–5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62–3.65), returning to baseline thereafter. Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications.
登录
查看更多内容
影响因子：
168.9
作者：
Pearse, Rupert M.;Moreno, Rui P.;Bauer, Peter;Pelosi, Paolo;Metnitz, Philipp;Spies, Claudia;Vallet, Benoit;Vincent, Jean-Louis;Hoeft, Andreas;Rhodes, Andrew
通讯作者：
Rhodes, Andrew
影响因子：
3
作者：
SILBER, JH;WILLIAMS, SV
通讯作者：
WILLIAMS, SV
白介素-1β在术后认知功能障碍中的作用。
影响因子：
11.2
作者：
Cibelli M;Fidalgo AR;Terrando N;Ma D;Monaco C;Feldmann M;Takata M;Lever IJ;Nanchahal J;Fanselow MS;Maze M
通讯作者：
Maze M
影响因子：
8.8
作者：
Steinmetz, Jacob;Christensen, Karl Bang;Rasmussen, Lars S.
通讯作者：
Rasmussen, Lars S.
影响因子：
7.2
作者：
Grocott, M. P. W.;Browne, J. P.;Mythen, M. G.
通讯作者：
Mythen, M. G.