外科医生压力与重大手术并发症之间的关联
Jake Awtry1,2, Sarah Skinner3, Stephanie Polazzi3
1Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA surgery
|January 15, 2025
概括
通过交感血管平衡测量外科医生生理应力的增加与较少的重大手术并发症有关. 这突显了外科医生的压力和患者的结果之间的复杂关系.
科学领域:
- 生理压力和外科手术的表现.
- 人为因素在手术中的作用
- 患者结局研究研究结果.
背景情况:
- 外科医生的压力会影响外科技巧和患者的治疗结果.
- 外科医生生理学压力与患者结果之间的关系尚未得到充分理解.
研究的目的:
- 为了调查外科医生生理学压力之间的关系,通过交感血管平衡评估,以及术后并发症.
- 探索外科医生的压力对多中心环境中的患者结果的影响.
主要方法:
- 未来的队列研究涉及793次手术手术在14个部门的4所大学医院.
- 通过在手术的最初5分钟内从心率变化 (HRV) 数据中测量低频率高频率 (LF:HF) 的比率来测量外科医生心血管平衡.
- 术后并发症,包括重大手术并发症,ICU住院和30天内的死亡率,使用多变量逻辑回归来分析.
主要成果:
- 外科医生交感血管平衡 (生理性压力的标志物) 的增加与重大手术并发症的显著减少有关 (调整后几率比率[AOR],0.63;95% CI,0.41-0.98).
- 观察到减少重症监护室停留时间 (AOR,0.34;95% CI,0.11-1.01) 和死亡率 (AOR,0.18;95% CI,0.03-1.03) 的趋势,尽管在统计学上并不显著.
- 该研究包括38名外科医生进行的793项手术,患者中位数年龄为62岁.
结论:
- 手术开始时外科医生的压力增加与改善的临床患者结果相关,特别是较少的重大并发症.
- 这项研究发现了可测量的外科医生生理因素与患者安全之间的新联系.
- 研究结果表明,通过理解和管理外科医生的压力,可以改善患者护理的潜在途径.
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