Identification and characterisation of the high-risk surgical population in the United Kingdom.
Identification and characterisation of the high-risk surgical population in the United Kingdom.
复制标题
英国高风险手术人群的识别和表征。
DOI：
10.1186/cc4928
复制
发表时间：
2006
期刊：
影响因子：
15.1
通讯作者：
Bennett, E. David
中科院分区：
文献类型：
--
作者：
Pearse, Rupert M.;Harrison, David A.;James, Philip;Watson, David;Hinds, Charles;Rhodes, Andrew;Grounds, R. Michael;Bennett, E. David
在英国，关于普通外科手术后的死亡率知之甚少。死亡在“高风险”手术人群中最常见，主要由老年患者组成，患有并存的内科疾病，接受大手术。目前只有有限的数据来描述这一人群。本研究的目的是估计高风险普通外科人群的规模，并描述结果和重症监护室（ICU）资源的使用。1999年1月至2004年10月期间，94家国民保健服务医院的住院普通外科手术和ICU入院数据摘自重症监护国家审计和研究中心数据库和CHKS数据库。高风险外科手术被前瞻性地定义为死亡率为5%或更高的手术。共有4，117，727例外科手术; 2，893，432例为择期手术（12，704例死亡; 0.44%），1，224，295例为急诊手术（65，674例死亡; 5.4%）。确定了513，924例患者的高风险人群（63，340例死亡; 12.3%），占死亡的83.8%，但仅占手术的12.5%。该人群的住院时间延长（中位数，16天;四分位数间距，9-29天）。有59，424人入住ICU（11，398人死亡; 19%）。在手术后直接进入ICU的患者中，有31，633例择期入院，3，199例死亡（10.1%），24，764例急诊入院，7，084例死亡（28.6%）。ICU停留时间较短（中位数，1.6天;四分位数间距，0.8-3.7天），但入住ICU的患者住院时间较长（中位数，16天;四分位数间距，10-30天）。在ICU人群中，40.8%的死亡发生在首次从ICU出院后。最高的死亡率（39%）发生在标准病房的初始术后护理后入住ICU的人群中。大量的高风险手术人群占外科手术的12.5%，但占死亡人数的80%以上。尽管死亡率很高，但这些患者中只有不到15%的人进入ICU。
Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9–29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8–3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10–30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU.
登录
查看更多内容
影响因子：
105.7
作者：
Tekkis, PP;Poloniecki, JD;Stamatakis, JD
通讯作者：
Stamatakis, JD
影响因子：
9.6
作者：
Bayly, PJM;Matthews, JNS;Thomas, DG
通讯作者：
Thomas, DG
DOI：
10.1308/003588402760452394
发表时间：
2002-09-01
影响因子：
1.4
作者：
Catto, JWF;Alexander, DJ
通讯作者：
Alexander, DJ
影响因子：
--
作者：
Goldacre, MJ;Roberts, SE;Yeates, D
通讯作者：
Yeates, D
影响因子：
9.6
作者：
Bennett-Guerrero, E;Hyam, JA;Parides, MK
通讯作者：
Parides, MK