Quality of Postoperative Care after Major Orthopedic Surgery Is Correlated with Both Long-term Cardiovascular Outcome and Troponin Ic Elevation
Quality of Postoperative Care after Major Orthopedic Surgery Is Correlated with Both Long-term Cardiovascular Outcome and Troponin Ic Elevation
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DOI：
10.1097/aln.0b013e3181eaacc4
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发表时间：
2010-09-01
期刊：
影响因子：
8.8
通讯作者：
Lenoir, Bernard
中科院分区：
文献类型：
--
作者：
Ausset, Sylvain;Auroy, Yves;Lenoir, Bernard
背景：本研究的目的是在接受重大骨科手术的患者中进行，以评估实践变化对通过肌钙蛋白Ic系列测量检测的术后心肌缺血（PMI）发生率和长期心脏预后的影响。方法：在3年的时间里，在一家多学科医院进行重大骨科手术后的头3天测量肌钙蛋白Ic。经过16个月的研究，术后护理得到改善。心源性死亡、心肌梗死和心力衰竭被认为是主要的心脏不良事件，并在住院期间和术后第一年进行记录。以PMI发生率和主要心脏不良事件发生率作为评价护理质量的结果指标，比较质量提升前（P1）和后（P2）的差异。结果：共纳入378例手术（P1, 123例；P2, 255例）。P1组和P2组的PMI和主要心脏不良事件发生率分别为8.9 vs 3.9% （P = 0.04）和8.1 vs 1.9% （P = 0.004）。通过对基线数据进行多变量Cox回归分析，与主要心脏不良事件发生相关的独立因素为P1期（风险比= 4.5；97.8%可信区间[CI]， 1.1-17.4）和PMI（风险比= 6.4;97.8% CI, 1.6-26.4）。结论：我们的骨科大手术术后护理政策与短期心脏结局（即PMI伴肌钙蛋白Ic释放）和长期心脏结局密切相关。因此，在给定的手术人群中，肌钙蛋白Ic升高发生率的变化可作为术后护理政策的结果指标。
Background: The aim of this study performed in patients undergoing major orthopedic surgery was to assess the impact of changes in practice on both the incidence of postoperative myocardial ischemia (PMI) detected by serial measurements of troponin Ic and long-term cardiac outcome.Methods: During a 3-yr period, troponin Ic was measured on the first 3 days after major orthopedic surgery in a multidisciplinary hospital. After 16 months of study, postoperative care was improved. Cardiac death, myocardial infarction, and cardiac failure were considered major adverse cardiac events and were recorded during the hospital stay and the first postoperative year. The incidences of PMI and major adverse cardiac events were used as result indicators for quality of care and compared before (P1) and after (P2) quality enhancement.Results: Three hundred seventy-eight surgical procedures were included (P1, 123; P2, 255). Incidences of PMI and major adverse cardiac events were 8.9 versus 3.9% (P = 0.04) and 8.1 versus 1.9% (P = 0.004) for P1 and P2, respectively. Using a multivariate Cox regression analysis adjusted for baseline data, independent factors associated with the occurrence of a major adverse cardiac event were phase P1 (hazard ratio = 4.5; 97.8% confidence interval [CI], 1.1-17.4) and PMI (Hazard ratio = 6.4; 97.8% CI, 1.6-26.4).Conclusions: Our postoperative care policy after major orthopedic surgery strongly correlated with both short-term cardiac outcome (i.e., PMI with troponin Ic release) and long-term cardiac outcome. Thus, in a given surgical population, variation of incidence of troponin Ic elevations could be used as a result indicator for postoperative care policy.