STudy of Risk Assessment To reduce complications In patients Following noncardiac surgerY (STRATIFY)

风险评估研究以减少非心脏手术后患者的并发症（STRATIFY）

• 批准号: nhmrc : 351475
• 负责人: Prof Bala Venkatesh
• 金额: $ 29.07万
• 依托单位: The University of Queensland
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2005
• 资助国家: 澳大利亚
• 起止时间: 2005-01-01 至 2007-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/study-risk-assessment-surgery-stratify/83135
• 关键词: STudy; Risk; Assessment; reduce; complications

Cardiac problems account for many complications in patients undergoing major non-cardiac surgery, and even apparently minor cardiac damage is a marker of high risk for subsequent adverse events. Unfortunately, while money and effort is expended on identifying patients at risk, the appropriate response to this risk is quite unclear. The performance of bypass surgery or balloon angioplasty in order to treat the underlying coronary disease of at-risk patients is used in other situations, and reduces longterm risk. However, in many patients undergoing major noncardiac surgery, this approach may be inappropriately aggressive, as these patients are often elderly, have other diseases that make heart operations more difficult and risky than usual, and in any case may have a reduced life expectancy from the disease necessitating the operation. As the most critical issue is to ensure that patients undergo their surgery uneventfully, an alternative is the use of intensive medical therapy to protect the heart. This multicentre study, based at Brisbane hospitals that perform large numbers of major operations, will follow up patients for complications, and outcome (including quality of life) will be assessed six months after the operation. We will address two important questions about the efficacy and cost of risk reduction strategies. First, in patients at higher levels of risk and with a positive stress test, could a combination of medical therapy designed to protect the heart be as effective as current approaches, which include the performance of bypass surgery or coronary balloon angioplasty? Second, in patients identified as being at some risk - but low risk - are drugs sufficiently effective to avoid the need for further testing to quantify risk? As the population continues to age, the numbers of at risk patients undergoing major surgery will increase, and answers to these questions will provide important information to guide their management.

在接受大型非心脏手术的患者中，心脏问题是许多并发症的原因，即使表面上看很小的心脏损伤也是后续不良事件的高风险标志。不幸的是，虽然在识别有风险的患者上花费了金钱和精力，但对这种风险的适当反应却相当不清楚。为了治疗高危患者潜在的冠状动脉疾病而进行的搭桥手术或球囊血管成形术也可用于其他情况，并降低长期风险。然而，在许多接受大型非心脏手术的患者中，这种方法可能具有不适当的侵略性，因为这些患者通常是老年人，患有其他疾病，使心脏手术比平时更困难和更危险，而且无论如何，这种疾病可能会缩短需要手术的疾病的预期寿命。由于最关键的问题是确保患者顺利完成手术，另一种选择是使用强化药物治疗来保护心脏。这项多中心研究的基础是布里斯班的医院，这些医院进行了大量的大手术，将跟踪患者的并发症，并将在手术后六个月评估结果(包括生活质量)。我们将解决关于降低风险战略的有效性和成本的两个重要问题。首先，在风险水平较高且压力测试呈阳性的患者中，旨在保护心脏的药物治疗组合能否像目前的方法一样有效，包括进行搭桥手术或冠状动脉球囊血管成形术？其次，对于被确定为存在一定风险--但风险较低--的患者，药物是否足够有效，以避免需要进一步的测试来量化风险？随着人口的不断老龄化，接受大手术的高危患者的数量将会增加，对这些问题的回答将为指导他们的管理提供重要信息。