- 學位論文
老年人術前貧血對術後不良事件和死亡率關係的研究
The correlation between preoperative anemia and postoperative adverse events in elderly patients
摘要
目的：本研究分析術前貧血的老年人，探討術後三十天內發生的不良事件和死亡率的相關。 方法：本文採用回溯性研究(retrospective study)，藉由分析台北市某醫學中心，於民國98年7月至民國100年6月間，大於65歲接受非心臟手術的病患資料，利用多變項羅吉斯迴歸(multivariable logistic regression)計算與術後三十天內發生死亡率、不良事件、手術部位感染、心肌梗塞、腦中風、急性腎衰竭、呼吸衰竭、心臟停止、再輸血、轉加護病房住及院天數延長之相關因子的危險比(odds ratio, OR)及95%信賴區間(confidence interval, CI)。 結果：本文分析了2,366位老年病人，結果顯示，相較於非術前貧血的人，術前貧血的病患，術後三十天內發生死亡率 (OR = 6.69﹔95% CI = 3.10-14.4)、不良事件(OR = 3.09﹔95% CI = 2.30-4.15)、手術部位感染(OR = 9.21﹔95% CI = 3.21-26.4)、腦中風(OR = 22.8﹔95% CI = 1.22-427)、呼吸衰竭(OR = 4.72﹔95% CI = 1.42-15.7)、再輸血(OR = 2.77﹔95% CI = 1.93-3.98)、轉加護病房(OR = 1.82﹔95% CI = 1.23-2.68)、住院天數延長(OR = 2.35﹔95% CI = 1.72-3.21)的危險較高。 結論：老年人術前貧血與術後發生的不良事件和死亡率有關， 通過治療術前貧血的情況，減少手術產生不良事件的風險。
並列摘要
Objective: We aimed to assess the relationship between preoperative anemia on 30-day postoperative adverse events and mortality in elderly surgical patients undergoing non-cardiac surgery. Methods: Data were retrospectively collected on non-cardiac surgical patients over 65 years old at one Taipei medical center between July 1 2009 and June 1 2011. The unadjusted and adjusted relationship between preoperative anemia and postoperative 30-day mortality and morbidity (surgical site infection, myocardial infarction, stroke, acute renal failure, respiratory failure, cardiac arrest, blood transfusion and ICU admission) were assessed by logistic regression. Results: We obtained data for 2366 elderly surgical patients. Compared with non-anemia elderly surgical patients, those with preoperative anemia were more likely to have increased postoperative 30-day mortality(OR = 6.69﹔95% CI = 3.10-14.4) and adverse events (OR = 3.09﹔95% CI = 2.30-4.15). Adverse events including surgical site infection(OR = 9.21﹔95% CI = 3.21-26.4), stroke(OR = 22.8﹔95% CI = 1.22-427), respiratory failure (OR = 4.72﹔95% CI = 1.42-15.7), blood transfusion(OR = 2.77﹔95% CI = 1.93-3.98), intensive care unit admission(OR = 1.82﹔95% CI = 1.23-2.68) and increased hospital length of stay (OR = 2.35﹔95% CI = 1.72-3.21), had a higher odds ratio in anemic elderly patients. Conclusion: Perioperative anemia is a risk factor of increased postoperative 30-day mortality and adverse events. Treatment of preoperative anemia is important for reduction of perioperative risk.