胃肠道外科手术中的多模式预康复:对患者结果的关键风险因素
Braxton Goodnight1, Jennifer Cook1, Melanie Koenen1
1Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO.
Surgery
|October 15, 2025
概括
预康复计划可以改善高风险患者的外科治疗结果. 然而,呼吸障碍患者可能不会完全受益,尽管进行了干预,但他们的再入院率更高.
科学领域:
- 手术 手术 手术 术 术
- 老年病的医生 老年病的医生
- 肺部病理学 肺部病理学
背景情况:
- 手术预先训练计划,如手术预训练和准备 (SPR) 提高了老年,高风险的手术患者的结果.
- 可能从预康复中获得较少益处的特定患者子组仍在调查中.
研究的目的:
- 在SPR计划中,在接受胃肠道手术的患者中确定非理想的术后结果的预测因素.
- 调查预康复干预是否充分解决导致不良结果的风险因素.
主要方法:
- 在39个月的时间里,300名接受胃肠道手术的高风险患者被纳入SPR计划.
- 多变量分析确定了非理想结果的预测因素 (设施出院,30天再入院或30天死亡).
- 使用ACS NSQIP手术风险计算器将观察到的结果与预期的结果进行了比较.
主要成果:
- 与预期的比率相比,参与者显示30天死亡率降低 (O/E:0.32) 和非家庭出院 (O/E:0.61).
- 尽管整体情况有所改善,20%的患者经历了非理想的结果,呼吸不全,充血性心力衰竭和开放手术更为常见.
- 呼吸障碍 (aOR: 2.48) 和扩散癌症 (OR: 3.41) 是非理想结果的独立风险因素,呼吸障碍与更高的再入院率有关 (O/E: 1.16).
结论:
- 在手术患者中,预康复干预可能无法完全缓解与呼吸障碍相关的风险.
- 呼吸不良是一种显著的,潜在的可修改的风险因素,导致胃肠道手术后再入院率更高.
- 需要进一步的研究,以优化患者的预康复策略有呼吸道疾病,如呼吸不良.
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