Background

Five million surgeries take place in the NHS each year. Little is known about the prevalence of chronic diseases among these patients, and the association with postoperative outcomes.

Methods

Analysis of routine data from all NHS hospitals in England including patients aged ≥18 yr undergoing non-obstetric surgery between January 1, 2010 and December 31, 2015. The primary outcome was death within 90 days after surgery. For each chronic disease, we adjusted for age, sex, presence of other diseases, emergency surgery, and year using logistic regression models. We defined high-risk diseases as those with an adjusted odds ratio (OR) for death ≥2 and report associated 2-yr survival.

Results

We included 8 624 611 patients (median age, 53 [36–68] yr), of whom 6 913 451 (80.2%) underwent elective surgery and 1 711 160 (19.8%) emergency surgery. Overall, 2 311 600 (26.8%) patients had a chronic disease, of whom 109 686 (4.7%) died within 90 days compared with 24 136 (0.4%) of 6 313 011 without chronic disease. Respiratory disease (1 002 281 [11.6%]), diabetes mellitus (662 706 [7.7%]), and cancer (310 363; 3.6%) were the most common. Four chronic diseases accounted for 7.7% of patients but 59.0% of deaths: cancer (37 693 deaths [12.1%]; OR=8.3 [8.2–8.5]), liver disease (8638 deaths [10.3%]; OR=4.5 [4.4–4.7]), cardiac failure (26 604 deaths [12.6%]; OR=2.4 [2.4–2.5]), and dementia (19 912 deaths [17.9%]; OR=2.0 [1.9–2.0]). Two-year survival was 67.7% among patients with high-risk chronic disease, compared with 97.1% without.

Conclusion

One in four surgical patients has a chronic disease with an associated 10-fold increase in risk of postoperative death. Two-thirds of all deaths after surgery occur among patients with high-risk diseases (cancer, cardiac failure, liver disease, dementia).

中文翻译：

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慢性病患者术后死亡：对英国 NHS 常规收集数据的前瞻性研究

背景

NHS 每年进行 500 万次手术。关于这些患者中慢性病的患病率以及与术后结果的关系知之甚少。

方法

分析来自英格兰所有 NHS 医院的常规数据，包括 2010 年 1 月 1 日至 2015 年 12 月 31 日期间接受非产科手术的 18 岁以上的患者。主要结果是术后 90 天内死亡。对于每种慢性疾病，我们使用逻辑回归模型调整了年龄、性别、是否存在其他疾病、急诊手术和年份。我们将高危疾病定义为死亡调整优势比 (OR) ≥2 并报告相关的 2 年生存率的疾病。

结果

我们纳入了 8 624 611 名患者（中位年龄，53 [36-68] 岁），其中 6 913 451 人（80.2%）接受了择期手术，1 711 160 人（19.8%）接受了急诊手术。总体而言，2 311 600 名（26.8%）患者患有慢性疾病，其中 109 686 人（4.7%）在 90 天内死亡，而 6 313 011 人中有 24 136 人（0.4%）没有慢性病。呼吸系统疾病（1 002 281 [11.6%]）、糖尿病（662 706 [7.7%]）和癌症（310 363；3.6%）是最常见的。四种慢性疾病占患者的 7.7%，但占死亡人数的 59.0%：癌症（37 693 人死亡 [12.1%]；OR=8.3 [8.2–8.5]）、肝病（8638 人死亡 [10.3%]；OR=4.5 [4.4] –4.7]）、心力衰竭（26 604 例死亡 [12.6%]；OR=2.4 [2.4–2.5]）和痴呆（19 912 例死亡 [17.9%]；OR=2.0 [1.9–2.0]）。高危慢性病患者的两年生存率为 67.7%，而无高危慢性病患者的两年生存率为 97.1%。

结论

四分之一的手术患者患有慢性疾病，术后死亡风险增加了 10 倍。三分之二的手术后死亡发生在患有高危疾病（癌症、心力衰竭、肝病、痴呆）的患者中。