在接受大手术的患者中多发病与术后死亡率之间的关联：欧洲29个国家的一项前瞻性研究
Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe
影响因子:6.90000
分区:医学1区 Top / 麻醉学1区
发表日期:2024 Sep
作者:
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摘要
多医生对医疗保健提供构成了全球挑战。这项研究旨在描述当代接受大型腹部手术的患者的多种病毒，常见疾病组合和结果的流行。这是对一项前瞻性，多中心研究的预期分析，该研究调查了在446个医院在29个欧洲欧洲29个国家的腹部大术进行的心血管并发症研究，该研究研究了腹部外科手术。主要结果是术后30天。次要结局指标是在手术后30天内发生并发症的发生率。有24,227例患者，7006（28.9％）的长期状况，有10,486（43.9％）具有多种多发性（两种或多种长期健康状况）。最常见的疾病是原发性癌症（39.6％）；高血压（37.9％）；慢性肾脏疾病（17.4％）；和糖尿病（15.4％）。与≤1个长期健康状况相比，多种病的患者的脆弱发生率更高。一项长期健康状况（调整后比值比1.93（95％CI 1.16-3.23）的患者死亡率较高）和多发病（调整后的优势比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)).接受术前医疗评估的多种病症患者的30天死亡率没有改善。多种疾病很常见，欧洲外科手术患者的结局很差。解决选修和急诊患者的多种疾病需要创新的策略，以说明脆弱和疾病的控制。多重警戒患者迫切需要这种策略的发展，这些策略将靶向整个手术途径以加强当前系统的整个手术途径。有必要进行介入试验，以确定针对多种多发性手术患者的有针对性管理的有效性。
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.