■使用当代全国代表性数据库,研究美国心脏手术后乳糜胸的流行病学和危险因素。
■我们通过国家住院患者样本数据库(2016-2019)确定了术后乳糜胸事件,并比较了基线人口统计学,合并症,以及术后乳糜胸住院和无乳糜胸住院之间的院内结局。Cochrane-Armitage检验用于分析发病率的趋势。多变量Poisson回归模型用于确定心脏手术后乳糜胸的潜在危险因素。
■共有819例(0.24%)入院与术后乳糜胸相关。乳糜胸的粗发生率和标准化发生率分别为23.7(95CI,22.1-25.4)和61.5/10000心脏手术相关入院,分别,在研究期间,发病率没有显著的时间变化(Ptrend=0.5249)。婴儿[调整率比率(ARR),117.3,95%置信区间(CI),94.5-145.5]和儿童(aRR,60.2,95CI,48.0-75.5)与成年人相比更容易发生乳糜胸。心脏和大血管手术(ARR,4.36,95CI,3.61-5.26),间隔修复(ARR,1.91、95CI、1.58-2.29),心脏移植(ARR,5.68,95CI,4.55-7.10)和心包手术(aRR,4.04,95CI,3.32-4.91)与乳糜胸风险升高相关。乳糜胸入院与较高的住院死亡率相关(4.9%与3.0%,p<0.0001),住院时间更长,更高的成本和更大的围手术期并发症负担。
■心脏手术后,乳糜胸是一种罕见但严重的并发症,影响预后。分析揭示了不同年龄段和特定外科手术的发病率不同,婴儿风险升高。
UNASSIGNED: To examine the epidemiology and risk factors of
chylothorax after cardiac procedure in the United States using a contemporary nationally representative database.
UNASSIGNED: We identified postoperative
chylothorax events through National Inpatient Sample database (2016-2019) and compared baseline demographics, comorbidities, and in-hospital outcomes between hospitalizations with and without postoperative chylothorax. The Cochrane-Armitage test was used to analyze trends in incidence rates. Multivariable Poisson regression models were used to identify potential risk factors for postoperative chylothorax after cardiac procedure.
UNASSIGNED: A total of 819 (0.24%) admissions were associated with postoperative
chylothorax. The crude and standardized incidence rates of
chylothorax were 23.7 (95%CI, 22.1-25.4) and 61.5 per 10,000 cardiac procedure-related admissions, respectively, with no significant temporal change in incidence rate over the study period (Ptrend = 0.5249). Infants [adjusted rate ratio (aRR), 117.3, 95% confidence interval (CI), 94.5-145.5] and children (aRR, 60.2, 95%CI, 48.0-75.5) were more likely to develop chylothorax compared to adults. Heart and great vessel procedures (aRR, 4.36, 95%CI, 3.61-5.26), septal repair (aRR, 1.91, 95%CI, 1.58-2.29), heart transplant (aRR, 5.68, 95%CI, 4.55-7.10) and pericardial procedures (aRR, 4.04, 95%CI, 3.32-4.91) were associated with elevated risk for chylothorax. Admissions with
chylothorax were associated with higher inpatient mortality (4.9% vs. 3.0%, p<0.0001), longer inpatient stay, higher costs and greater perioperative complication burden.
UNASSIGNED: Following cardiac procedures, chylothorax is an uncommon but serious complication that affects the prognosis. The analysis reveals varying incidence rates across age groups and specific surgical procedures, with infants at elevated risk.