The Significance of Preoperative Impaired Sensorium on Surgical Outcomes in Nonemergent General Surgical Operations
The Significance of Preoperative Impaired Sensorium on Surgical Outcomes in Nonemergent General Surgical Operations
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DOI：
10.1001/jamasurg.2014.863
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发表时间：
2015-01-01
期刊：
影响因子：
16.9
通讯作者：
Robinson, Thomas N.
中科院分区：
文献类型：
--
作者：
Gajdos, Csaba;Kile, Deidre;Robinson, Thomas N.
重要性随着人口老龄化，虚弱老年人的术前评估需要进行评估，而不仅仅是考虑慢性疾病。认知受损是虚弱老年人的公认特征。目的探讨术前感觉受损（IS）对普通外科手术结果的影响。设计、环境和参与者回顾性队列研究，使用2005年1月至2010年12月期间的数据，在参与美国外科医生学会国家手术质量改进计划的学术和社区医院进行。接受非紧急普通外科手术的患者进行了研究。多变量逻辑回归分析包括45个术前患者水平的危险因素和合并症，用于计算IS的条件概率。采用1：1贪婪匹配技术，将术前IS患者和未术前IS患者的倾向评分进行匹配。倾向评分匹配导致几乎所有（n = 1765）IS患者与无IS患者唯一匹配，导致队列大小为3530。术后并发症发生率和死亡率以下nonemergencygeneralsurgicaloperations.Results，共294037例患者进行了研究，其中1771（0.6%）术前IS。IS患者年龄较大，术前风险因素和合并症更显著。因此，未调整的分析发现，23例术后并发症中有22例明显更可能发生在IS患者中。在匹配队列中，术后肺炎、呼吸机依赖、进行性肾功能不全、尿路感染、卒中、静脉血栓栓塞、术后死亡率仍显著高于（P <0.05）。结论和相关性感觉受损显著增加术后发病率和死亡率，与其他术前风险因素和非急诊普通外科手术后的合并症无关。运营将认知功能受损纳入常规术前风险评估和决策可能是传统风险评估策略的重要补充。
IMPORTANCE With an aging population, preoperative assessment of the frail older adult requires evaluation beyond simply accounting for chronic diseases. Impaired cognition is a recognized characteristic of the frail older adult.OBJECTIVE To examine the effect of preoperative impaired sensorium (IS) on general surgical outcomes.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using data between January 2005 and December 2010 at academic and community hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing nonemergent general surgical operations were studied. Multivariable logistic regression involving 45 preoperative patient-level risk factors and comorbidities was used to calculate the conditional probability of having IS. Patients having and not having preoperative IS were matched on their propensity scores using a 1:1 greedy matching technique. Propensity score matching resulted in almost all (n = 1765) patients with IS uniquely matching to a patient without IS, resulting in a cohort size of 3530. Complication rates between patients with and without IS were compared.MAIN OUTCOMES AND MEASURES Rates of postoperative complications and death following nonemergent general surgical operations.RESULTS In total, 294 037 patients were studied, of whom 1771 (0.6%) had preoperative IS. Patients with IS were older and had more significant preoperative risk factors and comorbidities. As a result, unadjusted analysis found that 22 of 23 postoperative complications were significantly more likely to occur in patients with IS. Within the matched cohort, rates of postoperative pneumonia, ventilator dependence, progressive renal insufficiency, urinary tract infection, stroke, venous thromboembolism, and postoperative death continued to be significantly (P < .05) elevated in patients with IS.CONCLUSIONS AND RELEVANCE Impaired sensorium significantly increases postoperative morbidity and mortality independent of other preoperative risk factors and comorbidities following nonemergent general surgical operations. Incorporation of impaired cognitive function into routine preoperative risk assessment and decision making could be an important addition to traditional risk assessment strategies.