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首先不要伤害:预测老年急诊整体外科干预的徒劳性
Emanuele Lagazzi1, Alisha Yi2, Ikemsinachi C Nzenwa3
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Department of Surgery, Humanitas Research Hospital, Rozzano, Italy.
American journal of surgery
|July 18, 2024
概括
在老年人中,突发性手术带来高死亡风险. 败血性休克,不良的ASA状态和透析显著预测了不良结果,为关键护理决策提供了信息.
科学领域:
- 老年人手术是一门老年手术.
- 手术结果研究研究
- 关键护理医学 关键护理医学
背景情况:
- 新出现的外科条件经常影响老年患者,老年患者通常很脆弱.
- 评估风险概况对于该群体的临床决策和护理规划至关重要.
研究的目的:
- 在接受紧急开放腹部手术的老年患者中确定30天死亡率的预测因素.
- 为高风险手术患者提供护理目标和决策流程的信息.
主要方法:
- 对2015-2019年国家外科质量改善计划 (NSQIP) 数据库的分析.
- 包括65岁及以上接受紧急开放腹部手术的患者.
- 后勤回归建模以确定30天死亡率的重要预测因素.
主要成果:
- 在41029名患者中,13.6%的患者在30天内死亡.
- 关键的死亡预测因素包括ASA状态5 (aOR 9.7),败血症休克 (aOR 4.9) 和透析依赖 (aOR 2.1).
- 患有所有三个因素的患者面临极高的死亡率 (79.4%-100%取决于程序).
结论:
- 败血栓休克,美国麻醉学会 (ASA) 的地位和透析与老年人徒劳的手术干预密切相关.
- 这些发现有助于建立切实可行的护理目标,并支持患者和家人的知情决策.
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