诊断的脆弱性和存活率可通过手术或非手术进行可行的管理
Emily Mosher1, Hasan Nassereldine2, Jeffrey C McKibben3
1Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
Annals of surgery
|April 28, 2025
概括
对于八种常见疾病,手术治疗改善了整体生存率,但由于恢复时间长,非手术治疗可能对非常脆弱的患者更好. 这项研究比较了手术与非手术的结果,分层分为脆弱性.
科学领域:
- 老年人手术是一门老年手术.
- 医疗保健服务研究 医疗服务研究
- 相对的有效性比较
背景情况:
- 手术暂停改善了脆弱患者的结果,但未知非手术管理的结果.
- 虚弱显著影响患者在手术和非手术环境中的结果.
- 了解脆弱性特定的结果对于优化治疗策略至关重要.
研究的目的:
- 为了比较操作与非操作管理对八种常见条件的结果,按脆弱性分层.
- 评估脆弱对生存,无医院日和出院倾向的影响.
- 根据患者的脆弱程度,确定最佳的管理策略.
主要方法:
- 从2016年到2023年,在一个多医院系统中对49169名成年患者进行了观察性队列研究.
- 根据管理策略和脆弱性类别 (使用风险分析指数) 进行了具有里程碑意义的分析,比较了2年的生存率和365天的不入院日 (HFD-365).
- 术后停留时间和出院安排的二次分析.
主要成果:
- 操作管理与总体较低的死亡率 (1.3%对2.5%) 和大多数脆弱类别相关,除了非常脆弱 (8.1%对12.1%).
- 运营管理产生了更多的HFD-365,特别是对于非常脆弱的 (中位数为365日与361天).
- 虚弱与术后停留时间更长,出院时间更少有关 (OR=2.0).
结论:
- 由于手术后恢复时间延长,非常脆弱的患者可能更喜欢非手术治疗.
- 管理决策应考虑这些八种临床条件的个体脆弱性状态.
- 对脆弱性特异性治疗途径的进一步研究是有必要的.
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