Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival.
Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival.
复制标题
老年患者术后院内并发症的预后意义。
DOI：
10.1097/00000539-200302000-00051
复制
发表时间：
2003
影响因子：
5.7
通讯作者：
Leung,JacquelineM
中科院分区：
文献类型：
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作者：
Manku,Kawalpreet;Bacchetti,Peter;Leung,JacquelineM
为了确定住院术后并发症对长期生存的影响，我们前瞻性研究了≥70岁接受非心脏手术的连续患者。测量和评估潜在的临床危险因素与术后长期死亡率的关系。采用Kaplan-Meier法测定长期生存率。采用Cox比例风险模型分析生存率的多变量相关因素。研究组的生存率也与年龄和性别匹配的美国普通人群进行了比较。517名初次住院后存活的患者被研究。平均随访时间为28.6±12.8个月。517例患者中有164例（31.7%）在随访时死亡。癌症史（危险比[HR] 2.44, 95%可信区间[CI] 1.78-3.38， P< 0.0001）、ASA身体状况> II（危险比2.27,95% CI 1.61-3.21， P< 0.0001）、神经系统疾病（危险比1.59,95% CI 1.13-2.24， P= 0.008）、年龄（危险比1.42 / 10年，95% CI 1.11-1.81， P= 0.005）、术后肺部并发症（危险比2.41,95% CI 1.30-4.48， P= 0.005）和肾脏并发症（危险比6.07,95% CI 2.23-16.52， P< 0.0001）是降低长期生存率的重要独立预测因素。与美国人群相比，并发症患者术后前3个月的死亡风险比无并发症患者（HR 2.9， P= 0.023）更高（HR 7.3，与一般人群相比）。改善老年外科患者围手术期护理必须包括减少住院术后并发症的措施，特别是那些涉及肺和肾系统的并发症。
To determine the impact of in-hospital postoperative complications on long-term survival, we prospectively studied consecutive patients≥ 70 yr of age undergoing noncardiac surgery. Potential clinical risk factors were measured and evaluated for their association with the occurrence of long-term postoperative mortality. Long-term survival was determined by using the Kaplan-Meier method. Multivariate correlates of survival were analyzed with the Cox proportional hazards model. The survival of the study group was also compared with the age-and gender-matched general United States population. Five hundred seventeen patients who survived the initial hospitalization were studied. The mean follow-up duration was 28.6±12.8 mo. One hundred sixty-four of 517 patients (31.7%) were deceased at the time of follow-up. A history of cancer (hazard ratio [HR] 2.44, 95% confidence interval [CI] 1.78–3.38, P< 0.0001), ASA physical status> II (HR 2.27, 95% CI 1.61–3.21, P< 0.0001), neurologic disease (HR 1.59, 95% CI 1.13–2.24, P= 0.008), age (HR 1.42 per decade, 95% CI 1.11–1.81, P= 0.005), postoperative pulmonary complications (HR 2.41, 95% CI 1.30–4.48, P= 0.005), and renal complications (HR 6.07, 95% CI 2.23–16.52, P< 0.0001) were significant independent predictors of decreased long-term survival. Compared with the United States population, patients with complications had a greater increase in mortality risk in the first 3 mo after surgery (HR 7.3 versus general population) than those without complications (HR 2.9, P= 0.023). An effort to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.