[JAMA最新论文]:术中麻醉交接伴随不良预后风险增加 | 中国病理生理学会危重病医学专业委员会
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[JAMA最新论文]:术中麻醉交接伴随不良预后风险增加
2018年01月13日 时讯速递, 进展交流 暂无评论

Original Investigation

January 9, 2018

Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery

Philip M. Jones, Richard A. Cherry, Britney N. Allen, et al

JAMA. 2018;319(2):143-153. doi:10.1001/jama.2017.20040

Importance 背景

Handing over the care of a patient from one anesthesiologist to another occurs during some surgeries and might increase the risk of adverse outcomes.

部分手术期间可能出现患者的麻醉照护从一名麻醉科医生转交到另一名麻醉科医生的情况,这可能增加不良预后的风险。

Objective 目的

To assess whether complete handover of intraoperative anesthesia care is associated with higher likelihood of mortality or major complications compared with no handover of care.

与没有交接相比,评估术中麻醉的完全交接是否伴随病死率或严重并发症风险增加。

Design, Setting, and Participants 设计,场景及研究对象

A retrospective population-based cohort study (April 1, 2009-March 31, 2015 set in the Canadian province of Ontario) of adult patients aged 18 years and older undergoing major surgeries expected to last at least 2 hours and requiring a hospital stay of at least 1 night.

一项回顾性基于人口的队列研究(2009年4月1日至2015年3月31日间,加拿大安大略省),入选患者为18岁以上成人,接受大手术(预期手术时间持续至少2小时)且需住院至少一晚。

Exposure 暴露因素

Complete intraoperative handover of anesthesia care from one physician anesthesiologist to another compared with no handover of anesthesia care.

术中麻醉从一名麻醉医生完全交接给另一名医生,与没有交接相比较

Main Outcomes and Measures 主要预后指标

The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Secondary outcomes were the individual components of the primary outcome. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects.

主要预后指标为复合终点,包括30天内全因病死率,再次住院或严重并发症。次要预后指标为主要预后中的各个指标。采用倾向性评分的暴露因素倒数加权法评价校正后暴露因素的影响。

Results 结果

Of the 313 066 patients in the cohort, 56% were women; the mean (SD) age was 60 (16) years; 49% of surgeries were performed in academic centers; 72% of surgeries were elective; and the median duration of surgery was 182 minutes (interquartile [IQR] range, 124-255). A total of 5941 (1.9%) patients underwent surgery with complete handover of anesthesia care. The percentage of patients undergoing surgery with a handover of anesthesiology care progressively increased each year of the study, reaching 2.9% in 2015. In the unweighted sample, the primary outcome occurred in 44% of the complete handover group compared with 29% of the no handover group. After adjustment, complete handovers were statistically significantly associated with an increased risk of the primary outcome (adjusted risk difference [aRD], 6.8% [95% CI, 4.5% to 9.1%]; P < .001), all-cause death (aRD, 1.2% [95% CI, 0.5% to 2%]; P = .002), and major complications (aRD, 5.8% [95% CI, 3.6% to 7.9%]; P < .001), but not with hospital readmission within 30 days of surgery (aRD, 1.2% [95% CI, −0.3% to 2.7%]; P = .11).

队列共入选313066名患者,56%为女性;平均年龄(SD)为60 (16)岁;49%的手术在医学中心进行;72%的手术为择期手术;手术中位时间182分钟 (四分位区间 [IQR] ,124-255)。共有5941名(1.9%)患者术中麻醉完全交接。接受手术患者中麻醉完全交接的比例逐年增加,至2015年达到2.9%。未经校正时,完全交接组44%的患者出现主要预后终点,无交接组仅为29%。进行校正后,完全交接伴随主要预后终点显著增加(校正后风险差异 [aRD], 6.8% [95% CI, 4.5% to 9.1%]; P < .001),全因病死率h (aRD, 1.2% [95% CI, 0.5% to 2%]; P = .002),严重并发症 (aRD, 5.8% [95% CI, 3.6% to 7.9%]; P < .001)均显著增加,但手术后30天内再入院风险无改变 (aRD, 1.2% [95% CI, −0.3% to 2.7%]; P = .11)。

Conclusions and Relevance 结论与意义

Among adults undergoing major surgery, complete handover of intraoperative anesthesia care compared with no handover was associated with a higher risk of adverse postoperative outcomes. These findings may support limiting complete anesthesia handovers.

对于接受大手术的成年患者,与无交接相比,术中麻醉完全交接伴随术后不良预后风险增加。这些发现可能支持限制麻醉完全交接。

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