Mortality after surgery in Europe: a 7 day cohort study.
Mortality after surgery in Europe: a 7 day cohort study.
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DOI：
10.1016/s0140-6736(12)61148-9
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发表时间：
2012-09-22
期刊：
影响因子：
168.9
通讯作者：
Rhodes, Andrew
中科院分区：
文献类型：
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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
大手术后的临床结果在国家一级的描述很差。医院和卫生保健系统之间的异质性证据表明，有潜力改善对患者的护理，但这种潜力尚未得到证实。欧洲手术结局研究是一项国际研究，旨在评估欧洲非心脏手术后的结局。我们在2011年4月4日至4月11日期间进行了这项为期7天的队列研究。我们收集了描述28个欧洲国家498家医院中16岁及以上接受住院非心脏手术的连续患者的数据。患者随访最多60天。主要终点是住院死亡率。次要结局指标为住院时间和重症监护入院时间。我们使用χ2和Fisher精确检验比较分类变量，使用t检验或Mann-Whitney U检验比较连续变量。显著性设定为p<0.05。我们构建了多水平logistic回归模型，以调整国家间死亡率的差异。我们纳入了46539例患者，其中1855例（4%）在出院前死亡。 3599例（8%）患者在术后接受重症监护，中位住院时间为1.2天（IQR 0.9 - 3.6）。1358例（73%）死亡患者在手术后的任何阶段均未接受重症监护。各国的粗死亡率差异很大（从冰岛的1.2%[95% CI 0.0 - 3.0]到拉脱维亚的21.5%[16.9 - 26.2]）。调整混杂变量后，与英国（数据集最大的国家）相比，各国之间仍存在重要差异（OR范围为芬兰的0·44 [95% CI 0·19-1·05; p=0·06]至波兰的6·92 [2·37-20·27; p=0·0004]）。接受住院非心脏手术患者的死亡率高于预期。各国之间的死亡率差异表明，需要制定国家和国际战略，以改善对这类患者的护理。欧洲重症监护医学会、欧洲麻醉学会。
Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe. We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ2 and Fisher's exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries. We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19–1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland). The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients. European Society of Intensive Care Medicine, European Society of Anaesthesiology.