预测下肢再血管化后的伤口并发症
Ke Xu1, Brenda Lin2, Loreski Collado2
1Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Journal of vascular surgery
|November 20, 2023
概括
一个新的风险评分识别了伤口复杂性因子在下内血管再血管化后. 这个工具有助于预测和讨论接受开放式旁路手术的患者的风险.
科学领域:
- 血管外科 血管外科
- 手术结果研究研究.
- 医疗信息学 医疗信息学
背景情况:
- 伤口并发症是下内血管再循环化手术后的一个重要问题.
- 预测这些并发症对于患者管理和优化手术结果至关重要.
研究的目的:
- 开发一个简单的风险评分,以识别与开放性阴下再血管化后伤口并发症相关的关键因素.
- 为了实现更好的风险分层和知情的患者咨询.
主要方法:
- 利用退伍军人事务外科质量改进计划的国家数据集 (2005-2021年),包括22,114名接受选择性开放型下内血管化治疗的患者.
- 开发了一个使用三分之二导数集的风险预测模型,并在三分之一集上验证了它.
- 确定了八个独立的风险因素,并分配了整数得分,以将患者分为低风险,中度风险,高风险和非常高风险的伤口并发症组.
主要成果:
- 在衍生集中,整体伤口并发症率为9.7%.
- 确定的危险因素包括:年龄较大 (≤73),体重指数较高 (≥35 kg/m2),非西班牙裔白人种族,糖尿病,白细胞数量升高 (>9900/mm3),冠状动脉疾病不存在,手术时间较长 (>6小时),并发性股骨内关节切除术.
- 伤口并发症率在较高风险类别中显著增加 (4.5%低至23.8%非常高风险).
- 伤口并发症与重新手术和移植失败率的增加有关.
结论:
- 一个简单的,经过验证的风险预测模型有效地识别了在开放的下内血管再血管化后面伤口并发症风险较高的患者.
- 该模型利用随时可用的临床数据,在手术前讨论和患者护理规划中促进实际应用.
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