背景:非计划术后再插管(UPR)是一般手术和血管手术后严重不良结局的标志。
方法:对8809例成人患者进行回顾性分析,18岁及以上,患者于2013年1月至2016年9月在一家大型单中心城市医院接受了大型普通和血管手术.将患者分为经历过UPR的患者和没有经历过的患者。单变量和多元回归分析用于确定UPR的预测因子,以及UPR与术后不良结局的关联。所有回归模型的Hosmer-LemeshowP>0.05,C统计量>0.75,表明拟合优度和区别性。
结果:在8809名患者中,138(1.6%)经历了普遍定期审议。普通手术和血管手术患者的UPR发生率无统计学差异(p=0.53)。UPR高龄的独立预测因素(OR5.1,95CI3.5-7.5,p<0.01),较高的ASA状态(OR7.9,95CI5.6-11.1,p<0.01),CHF(OR7.0,95CI3.6-13.9,p=0.02),急性肾功能衰竭或透析(OR3.1,95CI1.8-5.7,p=0.01),体重减轻(OR5.2,95CI2.8-9.6,p=0.01),全身性脓毒症(OR4.8,95CI3.4-6.9,p<0.01),术前肌酐升高(OR4.2,95CI3.0-5.9,p=0.01),低蛋白血症(OR5.3,95%CI3.8-7.5,p=0.01),和贫血(OR4.0,95CI2.8-5.9,p<0.01)。手术后,UPR与死亡率增加相关(OR3.8,95CI2.7-5.2,p<0.01),肺部并发症(OR1.8,95CI1.7-2.0,p<0.01),肾脏并发症(OR2.6,95CI1.7-3.5,p<0.01),心脏并发症(OR4.6,95CI2.0-6.7,p<0.01),术后红细胞输注(OR5.7,95CI3.8-8.6,p<0.01),住院时间延长(OR1.8,95CI1.5-2.4,p<0.01)。
结论:UPR与术后发病率和死亡率显著相关。旨在减少非心脏手术后UPR发生率的围手术期管理,除了先前确定的预测因素外,还应针对术前贫血。
BACKGROUND: Unplanned postoperative reintubation (UPR) is a marker for severe adverse outcomes following general and vascular surgery.
METHODS: A retrospective analysis of 8809 adult patients, aged 18 years and older, who underwent major general and vascular surgery at a large single-center urban hospital was conducted from January 2013 to September 2016. Patients were grouped into those who experienced UPR and those who did not. Univariate and multivariate regression analyses were used to identify predictors of UPR, and association of UPR with adverse postoperative outcomes. All regression models had Hosmer-Lemeshow P > 0.05, and C-statistic >0.75, indicating excellent goodness-of-fit and discrimination.
RESULTS: Of the 8809 patients included, 138 (1.6%) experienced UPR. There was no statistical difference in incidence of UPR between general and vascular surgery patients (p = 0.53). Independent predictors of UPR advanced age (OR 5.1, 95%CI 3.5-7.5, p < 0.01), higher ASA status (OR 7.9, 95%CI 5.6-11.1, p < 0.01), CHF (OR 7.0, 95%CI 3.6-13.9, p = 0.02), acute renal failure or dialysis (OR 3.1, 95%CI 1.8-5.7, p = 0.01), weight loss (OR 5.2, 95%CI 2.8-9.6, p = 0.01), systemic sepsis (OR 4.8, 95%CI 3.4-6.9, p < 0.01), elevated preoperative creatinine (OR 4.2, 95%CI 3.0-5.9, p = 0.01), hypoalbuminemia (OR 5.3, 95% CI 3.8-7.5, p = 0.01), and anemia (OR 4.0, 95%CI 2.8-5.9, p < 0.01). Following surgery, UPR was associated with increased mortality (OR 3.8, 95%CI 2.7-5.2, p < 0.01), pulmonary complications (OR 1.8, 95%CI 1.7-2.0, p < 0.01), renal complications (OR 2.6, 95%CI 1.7-3.5, p < 0.01), cardiac complications (OR 4.6, 95%CI 2.0-6.7, p < 0.01), postoperative RBC transfusion (OR 5.7, 95%CI 3.8-8.6,p < 0.01), and prolonged hospitalization (OR 1.8, 95%CI 1.5-2.4, p < 0.01).
CONCLUSIONS: UPR is significantly associated with postoperative morbidity and mortality. Perioperative management aimed at decreasing incidences of UPR after noncardiac surgery should target preoperative anemia in addition to previously identified predictors.