Postoperative Mortality in The Netherlands A Population-based Analysis of Surgery-specific Risk in Adults
Postoperative Mortality in The Netherlands A Population-based Analysis of Surgery-specific Risk in Adults
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DOI：
10.1097/aln.0b013e3181d5f95c
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发表时间：
2010-05-01
期刊：
影响因子：
8.8
通讯作者：
Boersma, Eric
中科院分区：
文献类型：
--
作者：
Noordzij, Peter G.;Poldermans, Don;Boersma, Eric
背景：很少有数据可以系统地描述相当大的未经选择的患者群体的术后死亡率和趋势。方法：这项基于人群的研究使用了1991-2005年间荷兰102家医院370万例外科手术的登记。年龄大于20岁的患者接受了非日间病例的非日间开放手术。患者数据包括主要(出院)诊断、次要诊断、入院和出院日期、入院期间死亡、手术、年龄、性别，以及根据国际疾病分类第9版临床修改分类的有限数量的合并症。主要观察指标为术后全因死亡率。采用单因素和多因素Logistic回归分析手术方式与主要预后的关系。结果：全因死亡67,879例(1.85%)。在一个基于11个主要外科手术类别的模型中，乳房手术与最低的死亡率(调整后的发病率，0.07%)相关，而血管手术与最高的死亡率(调整后的发病率，5.97%)相关。在一个基于36个手术亚类的模型中，调整后的死亡率从髓核突出手术的0.07%到肝移植的18.5%不等。36类模型的C指数为0.88，显著高于常用修订心脏风险指数中与简单手术分类(低风险与高风险)相关的C指数(P<；0.001)。结论：这项基于人群的研究提供了整个手术谱的术后死亡率的详细和当代概览，可作为西方人群手术结果的参考标准。
Background: Few data are available that systematically describe rates and trends of postoperative mortality for fairly large, unselected patient populations.Methods: This population-based study uses a registry of 3.7 million surgical procedures in 102 hospitals in The Netherlands during 1991-2005. Patients older than 20 yr who underwent an elective, nonday case, open surgical procedure were enrolled. Patient data included main (discharge) diagnosis, secondary diagnoses, dates of admission and discharge, death during admission, operations, age, sex, and a limited number of comorbidities classified according to the International Classification of Diseases 9th revision Clinical Modification. The main outcome measure was postoperative all-cause mortality. Univariable and multivariable logistic regression analyses were applied to evaluate the relationship between type of surgery and the main outcome.Results: Postoperative all-cause death was observed in 67,879 patients (1.85%). In a model based on a classification into 11 main surgical categories, breast surgery was associated with lowest mortality (adjusted incidence, 0.07%), and vascular surgery was associated with highest mortality (adjusted incidence, 5.97%). In a model based on 36 surgical subcategories, the adjusted mortality ranged from 0.07% for hernia nuclei pulposus surgery to 18.5% for liver transplant. The c-index of the 36-category model was 0.88, which was significantly (P < 0.001) higher than the c-index that was associated with the simple surgical classification (low vs. high risk) in the commonly used Revised Cardiac Risk Index (c-index, 0.83).Conclusions: This population-based study provided a detailed and contemporary overview of postoperative mortality for the entire surgical spectrum, which may act as reference standard for surgical outcome in Western populations.