Predictors of perioperative complications in head and neck patients
Predictors of perioperative complications in head and neck patients
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DOI：
10.1001/archotol.128.5.505
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发表时间：
2002-05-01
影响因子：
--
通讯作者：
Futran, NA
中科院分区：
文献类型：
--
作者：
Farwell, DG;Reilly, DF;Futran, NA
背景：有重大内科问题需要进行重大耳鼻喉科手术的患者发生内科和外科并发症的风险很高。目的：探讨医学上有缺陷的耳鼻喉科大手术患者围手术期并发症的相关危险因素。方法：连续93例伴有严重内科合并症（如糖尿病、高血压）的患者行重大头颈部外科手术，并向医疗咨询中心进行术前评估和医疗管理。确定并记录患者和手术特征以及围手术期并发症。进行单因素和多因素分析以确定哪些特征与并发症相关。结果：术后并发症32例（34%）。26例（28%）患者有严重的内科并发症，18例（19%）患者有手术并发症。研究人群中未发生死亡。在单因素分析中，与所有并发症相关的因素包括肝炎史、皮瓣重建、肿瘤手术、术前放疗、术前胃造口放置、术中输血、麻醉时间（大于或等于8小时）以及术中补液和估计失血量较大的患者。只有麻醉时间（大于或等于8小时）在多变量分析中仍然具有独立的显著性。肝炎病史和麻醉时间延长是医学并发症的唯一独立预测因素。手术并发症的唯一独立预测因素是术中给液量。结论：麻醉时间延长8小时或更长，有肝炎病史，术中大容量液体复苏预测不良后果。必须特别注意在术前咨询这些病人，并在他们的手术和术后过程中照顾他们。
Background: Patients with significant medical problems requiring major otolaryngology procedures are at high risk for both medical and surgical complications.Objective: To identify risk factors associated with perioperative complications in medically compromised patients undergoing major otolaryngology procedures.Methods: Ninety-three consecutive patients with significant comorbid medical illnesses (eg, diabetes, hypertension) undergoing major head and neck surgical procedures were referred to a medical consultation center for preoperative assessment and medical management. Patient and surgical characteristics as well as perioperative complications were identified and recorded. Univariate and multivariate analyses were performed to determine which characteristics were associated with complications.Results: Thirty-two patients (34%) had postoperative complications. Twenty-six patients (28%) had serious medical complications, and 18 (19%) had surgical complications. No deaths occurred in the study population. On univariate analysis, the factors associated with all complications included history of hepatitis, flap reconstruction, oncologic surgery, preoperative radiation therapy, preoperative gastrostomy placement, intraoperative transfusion, anesthesia time (greater than or equal to8 hours), and those with greater intraoperative fluid replacement and estimated blood losses. Only anesthesia time (greater than or equal to8 hours) remained independently significant on multivariate analysis. A history of hepatitis and prolonged anesthesia time were the only independent predictors of medical complications. The only independent predictor of surgical complications was the volume of intraoperative fluid administered.Conclusions: Prolonged anesthesia times of 8 hours or more, a history of hepatitis, and large-volume intraoperative fluid resuscitations predicted adverse outcomes. Special care must be taken in counseling these patients preoperatively and in caring for them during their operative and postoperative course.