已知患有间质性肺病(ILD)的患者在手术后发展为急性加重(AE)。先前的研究已经评估了术后不良事件的预测因素。然而,目前尚不清楚这些研究的结果是否可以推广到不同类型的ILD患者和/或推断到接受非肺部手术的患者.本研究旨在阐明ILD患者全身麻醉手术后AE发展的预测因素。
我们进行了一项巢式匹配病例对照研究,纳入了最初的50840名患者队列中的700名患者。我们排除了接受实体器官或骨髓移植的患者。病例为ILD患者,术后30天内出现AE,而对照组没有发生AE。每个病例(n=28)与四个对照(n=112)性别匹配,一年的手术和30天内的多次手术。此外,多变量条件逻辑回归分析用于识别重要的预测因子,如p值<0.05所示。
在调整了潜在的混杂因素后,多变量条件逻辑回归分析确定了CT上的蜂窝(OR3.09;95%CI1.07至8.92),预测FVC<80%(OR4.21;95%CI1.46~12.2)和ARISCAT评分≥45(OR6.14;95%CI2.10~18.0)与术后AE的发生显著相关。
我们发现这三个因素是ILD患者术后不良事件发生的独立预测因素。这些预测因子是有利的,因为即使没有咨询有经验的肺科医师,外科医生和麻醉师也可以在手术前容易地对它们进行评估。
Patients with interstitial lung disease (ILD) are known to develop an acute exacerbation (AE) after surgery. Previous studies have evaluated the predictors of postoperative AE. However, it remains unclear whether the results of those studies can be generalised to patients with different types of ILD and/or extrapolated to those who undergo non-pulmonary surgery. This study aimed to elucidate the predictors of the development of AE after surgery with general anaesthesia in patients with ILD.
We conducted a nested matched
case-control study of 700 patients from an initial cohort of 50 840 patients. We excluded those who underwent solid organ or bone marrow transplantation. The cases were patients with ILD who developed AE within 30 days postoperatively, whereas the controls did not develop AE. Each
case (n=28) was matched with four controls (n=112) for sex, year of surgery and multiple operations within 30 days. Furthermore, a multivariable conditional logistic regression analysis was used to identify significant predictors, as indicated by a p value of <0.05.
After adjusting for potential confounders, the multivariable conditional logistic regression analysis identified honeycombing on CT (OR 3.09; 95% CI 1.07 to 8.92), a per cent predicted FVC <80% (OR 4.21; 95% CI 1.46 to 12.2) and an ARISCAT score ≥45 (OR 6.14; 95% CI 2.10 to 18.0) significantly associated with the development of postoperative AE.
We found that the three factors were independent predictors for the development of postoperative AE in patients with ILD. These predictors are advantageous because they can be readily evaluated before surgery by surgeons and anaesthesiologists even without consulting experienced pulmonologists.