多病共存与欧洲29国重大手术患者术后死亡率的关联：一项前瞻性研究

Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe

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ANAESTHESIA

影响因子:6.9

分区:医学1区 Top / 麻醉学1区

发表日期:2024 Sep

作者: ,

DOI: 10.1111/anae.16324

摘要

多病共存对全球医疗体系提出了挑战。本研究旨在描述接受重大腹部手术患者中多病共存的患病率、常见疾病组合及其结局。本研究为一项前瞻性、多中心、国际性研究的预先计划分析，调查欧洲29个国家446家医院进行的重大腹部手术后心血管并发症。主要结局为术后30天死亡率，次要结局为术后30天内的并发症发生率。在24,227名患者中，7006人（28.9%）患有一种长期疾病，10,486人（43.9%）患有多病共存（两种或以上的长期健康状况）。最常见的疾病包括原发癌（39.6%）、高血压（37.9%）、慢性肾病（17.4%）和糖尿病（15.4%）。多病共存患者的虚弱程度高于仅患一种健康状况的患者。患有一种长期疾病的患者的死亡率较高（调整后的比值比1.93，95% CI 1.16-3.23），多病共存者更是如此（调整后的比值比2.22，95% CI 1.35-3.64）。虚弱和ASA身体状况3-5中介了估计的31.7%的30天死亡率（调整后的比值比1.30，95% CI 1.12-1.51）以及36.9%的多病共存患者的30天死亡率（调整后的比值比1.61，95% CI 1.36-1.91）。在接受术前医疗评估的多病共存患者中，30天死亡率没有改善。多病共存普遍存在，且在欧洲的手术患者中预后较差。应对多病共存在择期和急诊患者中的挑战，需要创新策略以考虑虚弱和疾病控制。迫切需要制定整合护理的策略，覆盖整个手术路径，以加强现有系统，为多病共存患者提供支持。未来还需开展干预性试验，以验证有针对性的管理措施对多病共存手术患者的效果。

Abstract

Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery.This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery.Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16-3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35-3.64)). Frailty and ASA physical status 3-5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12-1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36-1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment.Multimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.