Improved trends in patient survival and decreased major complications after emergency ruptured abdominal aortic aneurysm repair.
Improved trends in patient survival and decreased major complications after emergency ruptured abdominal aortic aneurysm repair.
复制标题
紧急破裂腹主动脉瘤修复术后患者生存趋势改善，主要并发症减少。
DOI：
10.1016/j.jvs.2015.08.050
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发表时间：
2016
影响因子：
4.3
通讯作者：
S. Arya
中科院分区：
文献类型：
--
作者：
R. Brahmbhatt;J. Gander;Y. Duwayri;R. Rajani;R. Veeraswamy;A. Salam;T. Dodson;S. Arya
背景急诊腹主动脉瘤破裂（AAA）修复后患者生存率的改善趋势和主要并发症的减少。紧急AAA修补术有很高的发病率和死亡率。本研究旨在检查国家外科质量改进计划（NSQIP）数据库中的发病率和死亡率趋势，并确定潜在的危险因素。方法采用NSQIP数据库对2005 - 2011年所有急诊AAA修复进行鉴定。采用单因素分析（使用student检验、χ2检验和Fisher精确检验）和多因素logistic回归来检验死亡率和发病率的趋势。结果2761例急诊AAA修复患者中，321例（11.6%）在手术24小时内死亡。在剩余的2440例患者中，1133例（46.4%）出现严重并发症，459例（18.8%）在术后死亡。从2005年到2011年，患者死亡率显著下降，特别是围手术期存活的患者（P= 0.002）。总并发症增加（P< 0.0001）；然而，在存活超过24小时的患者中，主要并发症从2005年的58.7%下降到2011年的42.6% （P< 0.0001）。血管内主动脉修复（EVAR）的使用在研究期间增加（P< 0.0001）。在对超过最初24小时存活的患者进行多因素分析时，年龄增长（优势比[OR]， 1.1； 95%置信区间[CI]， 1.0-1.1）、慢性阻塞性肺疾病（优势比[OR]， 2.6; 95% CI, 1.7-4.1）、依赖功能状态（优势比，2.0;95% CI, 1.2-3.2）和存在主要并发症（优势比，3.1;95% CI, 2.0-5.0）与死亡显著相关，而存在老年住院医师（优势比，0.4;95% CI, 0.3-0.6）或同伴（优势比，0.3-0.6）与死亡显著相关。95% CI, 0.2-0.6)与死亡呈负相关。EVAR与死亡无关，但与30天并发症相关（OR, 0.5; 95% CI, 0.3-0.6）。结论：2005 - 2011年急诊AAA修复后患者生存率有所提高，特别是存活超过24小时的患者生存率显著提高。EVAR与死亡率无关，但对30天并发症有保护作用。虽然并发症的总数增加了，但主要并发症的数量在研究期间减少了，这表明更新的技术和患者护理方案可能正在改善结果。
BackgroundImproved trends in patient survival and decreased major complications after emergency ruptured abdominal aortic aneurysm (AAA) repair. Emergency AAA repair carries a high risk of morbidity and mortality. This study seeks to examine morbidity and mortality trends from the National Surgical Quality Improvement Program (NSQIP) database, and identify potential risk factors.MethodsAll emergency AAA repairs were identified using the NSQIP database from 2005 to 2011. Univariate analysis (using the Studentt,χ2, and Fisher's exact tests) and multivariate logistic regression was performed to examine trends in mortality and morbidity.ResultsOut of 2761 patients who underwent emergency AAA repair, 321 (11.6%) died within 24 hours of surgery. Of the remaining 2440 patients, 1133 (46.4%) experienced major complications and 459 (18.8%) died during the postoperative period. From 2005 to 2011, there was a significant decrease in patient mortality, particularly in patients who survived the perioperative period (P= .002). Total complications increased overall (P< .0001); however, major complications decreased from 58.7% in 2005 to 42.6% in 2011 (P< .0001) among patients who survived beyond 24 hours. The use of endovascular aortic repair (EVAR) increased over the study period (P< .0001). On multivariate analysis of patients who survived past the initial 24-hour period, advancing age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.1), chronic obstructive pulmonary disease (OR, 2.6; 95% CI, 1.7-4.1), dependent functional status (OR, 2.0; 95% CI, 1.2-3.2), and presence of a major complication (OR, 3.1; 95% CI, 2.0-5.0) were significantly associated with death, whereas presence of a senior resident (OR, 0.4; 95% CI, 0.3-0.6) or fellow (OR 0.3; 95% CI, 0.2-0.6) was inversely associated with death. EVAR was not associated with death, but was associated with 30-day complications (OR, 0.5; 95% CI, 0.3-0.6).ConclusionsPatient survival has increased from 2005 to 2011 after emergency AAA repair, with a significant improvement particularly in patients who survive past the first 24 hours. EVAR was not associated with mortality, but was protective of 30-day complications. Although the total number of complications increased, the number of major complications decreased over the study period, suggesting that newer techniques and patient care protocols may be improving outcomes.
DOI：
10.1056/nejmsa1303118
发表时间：
2013-09-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Tsai TC;Joynt KE;Orav EJ;Gawande AA;Jha AK
通讯作者：
Jha AK