外科手術の重複と外科手術後の結果の関連
Eric Sun1,2, Michelle M Mello2,3, Chris A Rishel1
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
JAMA
|February 27, 2019
まとめ
ほとんどの患者で重複手術は死亡率や合併症を増加させなかったが,手術の長さは増加した. 高リスクの患者は,重複した処置で死亡率と合併症が増加した.
科学分野:
- 手術の結果に関する研究
- 患者の安全
- 医療サービスに関する研究
背景:
- 複数の手術を同時に行うという重複手術は,患者の安全性と潜在的な悪影響について懸念を喚起します.
- 複数の手術が死亡率,合併症,処置期間に影響を及ぼすことを理解することは,手術の実践と患者のケアにおいて極めて重要です.
研究 の 目的:
- 手術の重複と入院死亡率,術後の合併症,手術の長さの関連を調査する.
- 特定の患者のサブグループが重複した手術でリスクが高いかどうかを特定する.
主な方法:
- 遡及的なコホート研究では,2010年から2018年にかけての様々な種類の手術 (全膝/股関節整形,脊椎手術,CABG,頭蓋骨切除) に関する66,430件の手術が分析されました.
- オーバーラップした手術は,少なくとも1時間のオーバーラップまたは1時間未満の症例の全期間と定義されました.
- 結果には,入院死亡率,重大/軽微な合併症,および退院までの追跡期間が含まれています.
主要な成果:
- オーバーラピング手術 (12%の症例) は,非オーバーラピング手術と比較して,病院での死亡率または全体的な合併症率の増加と有意に関連しませんでした.
- オーバーラップした手術の長さは (30分以上) 大きく増加した.
- 重複手術を受けた高リスク患者は,低リスク患者と比較して著しく高い死亡率と合併症を示した.
結論:
- 共同手術を受けた成人の重複手術は死亡率や合併症率の増加とは関係ありませんが,より長い手術期間と関連しています.
- 結果は,全体的なリスクは増加しないかもしれないが,特定の高リスクの患者集団は重複した手術で悪影響を受ける可能性があることを示唆している.
- 異なる患者のサブグループ内の重複手術の微妙な関連性を調べるためにさらなる研究が必要である.
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