术前危险因素影响住院时间 术后动脉再血管化后的危险因素影响住院时间
Justin C Weissberg1, Kshitij A Desai1, Michael C Stoner1
1Division of Vascular Surgery, University of Rochester Medical Center (URMC), Rochester, NY.
Annals of vascular surgery
|February 23, 2024
概括
这项研究确定了影响停留时间 (LOS) 的关键手术前因素,用于无症状大脑动脉狭窄症的跨动脉再血管化 (TCAR) 后. 识别这些因素可以帮助优化患者选择和TCAR程序的资源规划.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 穿动脉复血管化 (TCAR) 是一种用于动脉狭窄的混合程序.
- TCAR越来越多地用于无症状疾病,其风险概况与动脉内关节切除术相似.
- 术后停留时间 (LOS) 显著影响成本效益和质量结果.
研究的目的:
- 开发一个多变量回归模型,以确定影响TCAR后LOS的手术前变量,用于无症状动脉狭窄.
- 假设高风险的手术前患者因子对于 carotid endarterectomy 也会影响 TCAR 的 LOS.
- 为优化患者选择和可选TCAR资源规划提供一个工具.
主要方法:
- 这是一项多机构的回顾性研究,使用了血管外科协会血管质量倡议 (VQI) 数据库 (2016-2021).
- 包括接受TCAR的成人患者,用于神经保护的流量逆转,但不包括那些经历了长时间的手术前住院治疗的患者.
- 采用单变量分析和负二项式回归用于多变量建模,用于培训和验证的数据分割.
主要成果:
- 分析了13,483名患者,中位数的术后LOS为1.82天.
- 确定了损伤类型,年龄,性别,COPD,β阻塞剂使用,状体负担,高血压和种族作为影响LOS的重要因素 (P <0.05).
- 该模型准确地预测了86.04%的患者1天内LOS,94.51%的患者2天内LOS.
结论:
- 这项大规模分析反映了TCAR在无症状动脉疾病中的日益增长的使用情况.
- 从VQI数据中确定了明显增加术后LOS的术前变量.
- 开发的模型可以识别患有长期LOS风险的患者,有助于医疗保健效率和患者选择TCAR.
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