摘要
目的:本研究拟探讨在工作日与节假日不同时间进行急诊单纯冠状动脉旁路移植术(CABG)的安全性结果是否存在差异。方法:收集并回顾性分析2009年1月至2019年12月于阜外医院急诊行单纯CABG患者临床资料,比较工作日与节假日接受手术患者的术后30 d死亡率和并发症发生率。结果:本研究纳入2009年1月至2019年12月间共1393例急诊单纯CABG患者,其中工作日急诊单纯CABG患者1330例,节假日急诊单纯CABG患者63例。全组患者年龄(61.0±9.6)岁;其中女性占比26.4%(368/1393)。与工作日急诊患者手术相比,节假日急诊患者CABG后30 d死亡率、主动脉内球囊反搏置入、新发急性肾损伤、呼吸机通气时间>48 h、新发心肌梗死、新发脑梗死、输注血制品、肺部感染、二次开胸等多个并发症发生率显著增高(P均<0.05)。经风险矫正后(包括主刀医师等变量在内),上述终点依然存在显著性差异。节假日接受CABG急诊手术与复合终点事件(术后30 d死亡+术后新发心肌梗死+术后新发脑梗死+术后新发急性肾损伤)发生率显著相关(OR=3.1,95%CI:1.7~5.5,P<0.01)。结论:本研究提示节假日手术可能会影响急诊CABG近期结果。节假日期间接受急诊CABG患者术后死亡率及多种手术并发症发生率显著高于工作日接受急诊CABG患者。
Objectives:The aim of the current study was to examine whether there is increased 30-day mortality and in-hospital adverse clinical events after emergent/urgent coronary artery bypass grafting(CABG)on weekends/holidays in comparison with operations performed on weekdays.Methods:Present study retrospectively analyzed the clinical data of patients undergoing emergent/urgent CABG from January 2009 to December 2019 in our hospital.Short-term outcomes between patients undergoing emergent/urgent CABG surgeries on weekdays and those on weekends/holidays were compared.Results:A total of 1393 patients were included in this study,operation was performed in 1393 patients on weekdays and in 63 patients on weekends/holidays.Patients aged(61.0±9.6)years,the proportion of female was 26.4%(368/1393).Rates of 30-day mortality,postoperative IABP,new-onset acute kidney injury,prolonged ventilation(≥48 h),new-onset acute myocardial infarction,new-onset stroke,transfusion,pneumonia,reoperation were significantly higher in patients receiving surgeries on weekends/holidays than in patients receiving surgeries on weekdays(all P<0.05).After risk adjustment,weekends/holidays surgery remained as a determinant for increased risk of above events.Emergent/urgent CABG on weekends/holidays were associated with increased risk of composite endpoint,including 30-day mortality,new-onset acute myocardial infarction,new-onset stroke,new-onset acute renal injury(OR=3.1;95%CI:1.7-5.5;P<0.01).Conclusions:Short-term outcomes of emergent/urgent isolated CABG surgery seems to be significantly affected by the timing of surgery.Weekends/holidays surgeries are associated with increased rates of 30-day mortality and postoperative complications.
作者
胡展
袁昕
凤玮
HU Zhan;YUAN Xin;FENG Wei(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing,100037,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第7期646-650,共5页
Chinese Circulation Journal
基金
北京市科技新星计划基金资助项目(Z201100006820003)。
关键词
冠状动脉分流术
死亡率
手术后并发症
节假日
coronary artery bypass grafting
mortality
postoperative complications
holidays
