什么决定了多重新操作的结果? 患者和手术复杂性的影响
Joshua E Insler1, Aaron E Tipton1, Faisal G Bakaeen1
1Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
The Journal of thoracic and cardiovascular surgery
|December 11, 2023
概括
现在人们更好地了解了重复手术多心脏手术的结果. 选择性,孤立的手术的死亡率很低,但复杂性和患者因素增加了手术风险.
科学领域:
- 心血管外科心血管外科
- 心脏门的修复和更换
- 手术结果研究研究.
背景情况:
- 重复手术多心脏手术是复杂的,结果还不清楚.
- 了解患者的特征和手术因素对于改善结果至关重要.
研究的目的:
- 为了评估患者变量和影响手术后死亡率的手术组件在重复手术多心脏手术.
- 在这个患者群体中确定手术后死亡率的风险因素.
主要方法:
- 从2008年到2022年,对2324名心脏手术患者进行了2352次重复手术的回顾性分析.
- 利用随机森林对不平衡的数据来确定操作死亡率的预测因素.
- 根据组件数量 (门手术,大动脉手术,CABG,AF手术) 评估手术复杂性.
主要成果:
- 整体手术死亡率为4.2%,选择性,孤立的多门重复手术 (1.7%) 的比率明显较低.
- 每一个额外的外科手术组件都增加了手术死亡率,从2组件的2.4%增加到≥5组件的17%.
- 术后死亡率的关键预测因素包括冠状动脉旁路移植,手术紧急,心脏/功能障碍,外围动脉疾病,NYHA类和贫血.
结论:
- 选择性,孤立的重复手术多门手术可以在低的手术死亡率下进行.
- 手术复杂性和患者的生理状态对于风险分层和手术决策至关重要.
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