Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery
Postdischarge Complications Predict Reoperation and Mortality after Otolaryngologic Surgery
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出院后并发症可预测耳鼻喉科手术后的再次手术和死亡率
DOI：
10.1177/0194599813505078
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
B. Judson
中科院分区：
文献类型：
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作者：
Michelle M. Chen;S. Roman;J. Sosa;B. Judson
目的（1）确定耳鼻喉科住院患者术后30天内出院后并发症（PDCs）的发生率及其危险因素。(2)评价PDC与再手术风险和死亡率之间的相关性。研究设计回顾性队列研究。设置美国外科医师学会国家外科质量改进计划（2005-2011）。研究对象和方法：我们确定了48,028例接受住院耳鼻喉科手术的成人患者。关注的结局包括术后前30天内的并发症、再次手术和死亡率。统计分析包括卡方检验、t检验和多元回归。结果喉切除术、唇手术和舌/口底手术的PDC发生率最高（分别为8.0%、7.4%和4.1%）。在出院后的前48小时、一周和2周内，分别有10%、44%和73%的PDCs发生。常见的PDC包括手术部位感染（53.6%）、其他感染（37.4%）和静脉血栓栓塞事件（7.4%）。多因素分析表明，年龄的增加（比值比[OR] = 1.01; 95%置信区间[CI]，1.01-1.02），手术时间延长（OR = 1.68; 95%CI，1.39-2.03），住院时间>1天（OR = 1.49; 95%CI，1.18-1.86）和美国麻醉医师协会（阿萨）分级≥3（OR = 1.45; 95%CI，1.18-1.78）与PDC独立相关。PDCs患者更可能死亡（0.9% vs 0.1%，P <0.001）或再次手术（10.4% vs 1.2%，P <0.001）。结论这是首次对耳鼻喉科手术后的总体出院后事件进行研究。耳鼻喉科的PDC发生率发生在出院后不久，具有手术特异性，并与再次手术和死亡率相关。针对高风险患者的针对性手术分诊和随访计划可能会改善结局。
Objectives (1) Determine procedure-specific rates of postdischarge complications (PDCs) and their risk factors in the first 30 days following inpatient otolaryngologic surgery. (2) Evaluate association between PDCs and risk of reoperation and mortality. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program (2005-2011). Subjects and Methods We identified 48,028 adult patients who underwent inpatient otolaryngologic surgery. Outcomes of interest included complications, reoperation, and mortality in the first 30 days following surgery. Statistical analysis included chi-square, t tests, and multivariate regression. Results Laryngectomy, lip, and tongue/floor of mouth surgery had the highest PDC rates (8.0%, 7.4%, and 4.1%, respectively). Within the first 48 hours, week, and 2 weeks post discharge, 10%, 44%, and 73% of PDCs occurred, respectively. Common PDCs included surgical site infections (53.6%), other infections (37.4%), and venous thromboembolic events (7.4%). Multivariate analysis demonstrated that increasing age (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.01-1.02), prolonged operative time (OR = 1.68; 95% CI, 1.39-2.03), hospital stay >1 day (OR = 1.49; 95% CI, 1.18-1.86), and American Society of Anesthesiologists (ASA) class ≥3 (OR = 1.45; 95% CI, 1.18-1.78) were independently associated with PDCs. Patients with PDCs were more likely to die (0.9% vs 0.1%, P < .001) or have a reoperation (10.4% vs 1.2%, P < .001). Conclusion This is the first study of overall postdischarge events after otolaryngologic surgery. PDC rates in otolaryngology occur soon after discharge, are procedure specific, and are associated with reoperation and mortality. Targeted procedure-specific triage and follow-up plans for high-risk patients may improve outcomes.