Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators.
Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators.
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DOI：
10.1001/jamasurg.2016.4065
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发表时间：
2017-02-01
期刊：
影响因子：
16.9
通讯作者：
Vidal Melo MF
中科院分区：
文献类型：
--
作者：
Fernandez-Bustamante A;Frendl G;Sprung J;Kor DJ;Subramaniam B;Martinez Ruiz R;Lee JW;Henderson WG;Moss A;Mehdiratta N;Colwell MM;Bartels K;Kolodzie K;Giquel J;Vidal Melo MF
术后肺部并发症(PPC)是导致手术效果不佳的主要原因，其病理生理、严重程度和报告的准确性各不相同。前瞻性研究高危外科人群的临床和放射学PPC和呼吸功能不全治疗。我们在7个美国学术机构进行了一项多中心前瞻性观察研究。美国麻醉学家协会的身体状况2014年5月至11月期间，有3名患者接受了非心胸手术，需要全麻或更长时间的机械通气。我们假设，即使是轻微的PPC，也会与术后早期死亡率和医院资源的使用有关。我们分析了它们与可修改的围手术期变量之间的关系。非心胸外科手术。对发生在术后前7天内的预定义PPC进行前瞻性鉴定。我们使用双变量和Logistic回归分析来研究PPC与呼吸机和其他围手术期变量的关系。这项研究包括1202名患者，他们主要接受了腹部、矫形和神经手术。患者的平均年龄(SD)为62.1(13.8)岁，其中636(52.9%)为男性。401例(33.4%)至少发生1次PPC，其中235例(19.6%)需经鼻插管长时间氧疗，206例(17.1%)肺不张。有1个或多个PPC的患者，即使是轻微的，也显著增加了术后早期死亡率、重症监护病房(ICU)入院时间和ICU/住院时间。显著的PPC危险因素包括不可改变的(急症[是与否]：优势比[OR]，4.47，95%CI，1.59-12.56；手术部位[腹部/盆腔与非腹部/盆腔]：OR，2.54，95%CI，1.67-3.89；年龄[年数]：OR，1.03，95%CI，1.02-1.05)和可能可改变的(胶体注射[是与否]：OR，1.75，95%CI，1.03-2.97；术前氧合：OR，0.86，95%CI，0.80~0.93；失血量[毫升]：OR，1.17，95%CI，1.05~1.30；麻醉时间[分钟]：OR，1.14，95%CI，1.05~1.24；潮气量[毫升/公斤预计体重]：OR，1.12，95%CI，1.01~1.24)因素。术后肺部并发症在美国麻醉学家协会身体状况3的患者中很常见，尽管目前的保护性呼吸机实践。即使是轻微的PPC也会增加术后早期死亡率、ICU入院时间和住院时间(ICU和医院)。轻度频繁的PPC(如肺不张和需要长时间氧疗)应该得到更多的关注和干预，以改善围手术期的结果。
Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Noncardiothoracic surgery. Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59–12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67–3.89; and age [in years]: OR, 1.03, 95% CI, 1.02–1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03–2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80–0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05–1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05–1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01–1.24) factors. Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.