肝切除術後の計画外集中治療室入室のリスク因子：コホート研究
Alejandro Brañes1, Brianna Greenberg2, Alexandra W Acher2
1Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario, M5T 1P5, Canada; Division of Surgery, Hospital Dr. Sótero del Río, Avenida Concha y Toro 3459, Santiago, Republic of Chile.
Background:
Postoperative unplanned intensive care unit (ICU) admission is associated with increased cost and poor survival. The impact of perioperative factors on unplanned ICU admission after hepatectomy is unclear.
Methods:
An analysis of participants in the Hemorrhage During Liver Resection: Tranexamic Acid (HeLiX) randomized trial was conducted. Participants were stratified by ICU admission status: no, planned, and unplanned. Multivariable multinomial logistic regression analysis was performed to determine variables associated with unplanned ICU admission and 90-day mortality was calculated.
Results:
Of 1240 patients included, 868 (70 %) had no, 322 (26 %) had planned, and 50 (4 %) had unplanned ICU admission. On multivariable multinomial logistic regression analysis, prior cardiovascular disease (Relative Risk Ratio (RRR) 2.03; 95 % Confidence Interval (CI) 1.01-4.08), major liver resection (RRR 2.18; 95 % CI 1.12-4.27) and estimated blood loss per 500 mL (RRR 1.38; 95 % CI 1.23-1.55) were significantly associated with unplanned ICU admission. 90-day mortality rate for no, planned, and unplanned ICU admission was 1 %, 5 % and 16 %, respectively.
Conclusion:
Prior cardiovascular disease, major liver resection, and higher estimated blood loss were associated with unplanned ICU admission and increased perioperative mortality after hepatectomy. Consideration should be given to early monitoring of patients with these risk factors to decrease mortality.
