术后并发症影响普通手术患者心脏骤停后的生存率
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Postoperative Complications Affecting Survival After Cardiac Arrest in General Surgery Patients
背景与目的
普通手术患者术后心脏骤停罕见但却与其死亡率高度相关，且往往伴有术后并发症。而普通手术患者心脏骤停之前的并发症与心脏骤停之后的死亡率之间的关系尚未得到完全证实。
方 法
通过2012-2013年美国外科学会全国外科质量改进计划获得了术后日（POD）＃0（至POD＃30）发生心脏骤停患者的数据，并对其进行回顾观察性研究，前期并发症定义为以下至少有一种发生在心脏骤停之前：（1）急性肾损伤; （2）急性呼吸衰竭; （3）深静脉血栓形成/肺栓塞; （4）心肌梗死; （5）败血症/败血性休克; （6）中风; 和/或（7）输血。采用Cox比例风险模型进行评估心脏骤停之前的并发症和心脏骤停之后的死亡率之间的关系以对术前危险因素进行调整。
结 果
在1352例术后发生心脏骤停的患者中，746例（55％）发生心脏骤停前至少有1例并发症。 30天内总死亡率为71％（958/1352），且前期有无并发症患者的死亡率相似（71％[533/746] vs 70％[425/606]; P = .60）。 经调整后的Cox模型（风险比为1.03; 95％置信区间，0.90-1.18; P = .70），与前期无并发症的患者相比，前期有并发症患者的死亡率并没有增加。 此外，前期并发症并未与个别分析中死亡率的增加有关。
结 论
在POD＃0且发生心脏骤停的普通手术患者中，心脏骤停前的并发症常见但却与心脏骤停之后的死亡率增加无关。
原始文献摘要
Kim, Minjae MD, MS; Li, Guohua MD, DrPH Postoperative Complications Affecting Survival After Cardiac Arrest in General Surgery Patients Anesthesia & Analgesia: Post Author Corrections: September 07, 2017 doi: 10.1213/ANE.0000000000002460
Abstract：
BACKGROUND: Postoperative cardiac arrest is uncommon but associated with a high mortality risk in general surgery patients and is often preceded by postoperative complications. The relationships between previous complications and mortality after cardiac arrest in general surgery patients have not been completely evaluated.
METHODS: A retrospective, observational cohort of general surgery in patients with cardiac arrest occurring after postoperative day (POD) #0 (and up to POD #30) was obtained from the 2012–2013 American College of Surgeons National Surgical Quality Improvement Program.
Previous complication was defined as at least one of the following occurring before the POD of cardiac arrest: (1) acute kidney injury; (2) acute respiratory failure; (3) deep vein thrombosis/pulmonary embolus; (4) myocardial infarction; (5) sepsis/septic shock; (6) stroke; and/or
(7) transfusion. The associations between previous complications and mortality after cardiac arrest were assessed using Cox proportional hazards models that adjusted for preoperative risk factors.
RESULTS: Of 1352 patients with postoperative cardiac arrest, 746 patients (55%) developed at least 1 complication before cardiac arrest. Overall 30-day mortality was 71% (958/1352) and was similar among patients with and without a previous complication (71% [533/746] vs 70% [425/606]; P = .60). Patients with previous complications did not have an increased risk of mortality, compared to patients without previous complications, in adjusted Cox models (hazard ratio, 1.03; 95% confidence interval, 0.90–1.18; P = .70). In addition, no previous complication was associated with increased mortality risk in individual analyses.
CONCLUSIONS: Among general surgery patients with cardiac arrest after POD #0, complications occurring before cardiac arrest are common but are not associated with increased mortality risk. (Anesth Analg 2017;XXX:00–00)
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