Vito D Bruno, Bleri Celmeta, Tommaso Viva, Arturo Bisogno, Antonio Miceli, Mattia Glauber
{"title":"微创瓣膜手术后住院时间延长的风险预测模型。","authors":"Vito D Bruno, Bleri Celmeta, Tommaso Viva, Arturo Bisogno, Antonio Miceli, Mattia Glauber","doi":"10.1177/15569845241289429","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive surgery determines shorter postoperative hospital length of stay (LOS) even in cardiac surgery. Potential preoperative factors affecting LOS are still not known in minimally invasive heart valve surgery (MIVS). We aimed to identify preoperative variables influencing prolonged LOS in MIVS.</p><p><strong>Methods: </strong>We reviewed 189 patients who underwent MIVS via minithoracotomy at our institution. Prolonged LOS was defined as more than 7 postoperative days. Poisson and logistic regression were used to screen the predictors.</p><p><strong>Results: </strong>The mean postoperative LOS was 9.13 days, and 64 patients (33.9%) experienced a prolonged LOS. These patients were older, more frequently in New York Heart Association (NYHA) class III or IV, showed worse left ventricular ejection function (LVEF), and had a higher incidence of reoperation and chronic kidney disease (CKD). At univariate analysis, the most significant preoperative factors affecting prolonged LOS were age (odds ratio [OR] = 1.04), NYHA class III or IV (OR = 3.03), reduced LVEF (OR = 3.22), CKD (OR = 2.7), and redo surgery (OR = 3.6). After adjustment, the most significant preoperative factors predicting prolonged LOS were age (OR = 1.03, 95% CI: 1.01 to 1.06, <i>P</i> = 0.02) and redo surgery (OR = 3.33, 95% CI: 1.29 to 8.9, <i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>The most important factors affecting prolonged LOS after MIVS were represented by age and redo surgery, although other preoperative characteristics such as reduced LVEF, NYHA class III or IV, and CKD play a significant role in delaying recovery after MIVS. Further larger studies are needed to better identify potential preoperative predictors of prolonged LOS after MIVS.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Risk Prediction Model for Prolonged Length of Stay After Minimally Invasive Valve Surgery.\",\"authors\":\"Vito D Bruno, Bleri Celmeta, Tommaso Viva, Arturo Bisogno, Antonio Miceli, Mattia Glauber\",\"doi\":\"10.1177/15569845241289429\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Minimally invasive surgery determines shorter postoperative hospital length of stay (LOS) even in cardiac surgery. Potential preoperative factors affecting LOS are still not known in minimally invasive heart valve surgery (MIVS). We aimed to identify preoperative variables influencing prolonged LOS in MIVS.</p><p><strong>Methods: </strong>We reviewed 189 patients who underwent MIVS via minithoracotomy at our institution. Prolonged LOS was defined as more than 7 postoperative days. Poisson and logistic regression were used to screen the predictors.</p><p><strong>Results: </strong>The mean postoperative LOS was 9.13 days, and 64 patients (33.9%) experienced a prolonged LOS. These patients were older, more frequently in New York Heart Association (NYHA) class III or IV, showed worse left ventricular ejection function (LVEF), and had a higher incidence of reoperation and chronic kidney disease (CKD). At univariate analysis, the most significant preoperative factors affecting prolonged LOS were age (odds ratio [OR] = 1.04), NYHA class III or IV (OR = 3.03), reduced LVEF (OR = 3.22), CKD (OR = 2.7), and redo surgery (OR = 3.6). After adjustment, the most significant preoperative factors predicting prolonged LOS were age (OR = 1.03, 95% CI: 1.01 to 1.06, <i>P</i> = 0.02) and redo surgery (OR = 3.33, 95% CI: 1.29 to 8.9, <i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>The most important factors affecting prolonged LOS after MIVS were represented by age and redo surgery, although other preoperative characteristics such as reduced LVEF, NYHA class III or IV, and CKD play a significant role in delaying recovery after MIVS. Further larger studies are needed to better identify potential preoperative predictors of prolonged LOS after MIVS.</p>\",\"PeriodicalId\":13574,\"journal\":{\"name\":\"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/15569845241289429\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15569845241289429","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目的:即使在心脏外科手术中,微创手术也能缩短术后住院时间(LOS)。在微创心脏瓣膜手术(MIVS)中,影响住院时间的潜在术前因素尚不清楚。我们旨在确定影响微创心脏瓣膜手术住院时间延长的术前变量:我们回顾了在本院通过小切口进行微创心脏瓣膜手术的 189 例患者。LOS 延长定义为术后超过 7 天。采用泊松和逻辑回归筛选预测因素:术后平均住院时间为 9.13 天,64 名患者(33.9%)的住院时间延长。这些患者年龄较大,多为纽约心脏病协会(NYHA)Ⅲ级或Ⅳ级患者,左心室射血功能(LVEF)较差,再次手术和慢性肾病(CKD)的发生率较高。在单变量分析中,术前对延长 LOS 影响最大的因素是年龄(比值比 [OR] = 1.04)、NYHA III 级或 IV 级(OR = 3.03)、左心室射血功能降低(OR = 3.22)、慢性肾脏病(OR = 2.7)和再次手术(OR = 3.6)。经调整后,预测LOS延长的最重要术前因素是年龄(OR = 1.03,95% CI:1.01至1.06,P = 0.02)和再次手术(OR = 3.33,95% CI:1.29至8.9,P = 0.01):影响 MIVS 术后 LOS 延长的最重要因素是年龄和再次手术,尽管其他术前特征,如 LVEF 降低、NYHA III 级或 IV 级和 CKD 在延迟 MIVS 术后恢复方面也起着重要作用。需要进一步开展更大规模的研究,以更好地确定术前预测 MIVS 术后 LOS 延长的潜在因素。
A Risk Prediction Model for Prolonged Length of Stay After Minimally Invasive Valve Surgery.
Objective: Minimally invasive surgery determines shorter postoperative hospital length of stay (LOS) even in cardiac surgery. Potential preoperative factors affecting LOS are still not known in minimally invasive heart valve surgery (MIVS). We aimed to identify preoperative variables influencing prolonged LOS in MIVS.
Methods: We reviewed 189 patients who underwent MIVS via minithoracotomy at our institution. Prolonged LOS was defined as more than 7 postoperative days. Poisson and logistic regression were used to screen the predictors.
Results: The mean postoperative LOS was 9.13 days, and 64 patients (33.9%) experienced a prolonged LOS. These patients were older, more frequently in New York Heart Association (NYHA) class III or IV, showed worse left ventricular ejection function (LVEF), and had a higher incidence of reoperation and chronic kidney disease (CKD). At univariate analysis, the most significant preoperative factors affecting prolonged LOS were age (odds ratio [OR] = 1.04), NYHA class III or IV (OR = 3.03), reduced LVEF (OR = 3.22), CKD (OR = 2.7), and redo surgery (OR = 3.6). After adjustment, the most significant preoperative factors predicting prolonged LOS were age (OR = 1.03, 95% CI: 1.01 to 1.06, P = 0.02) and redo surgery (OR = 3.33, 95% CI: 1.29 to 8.9, P = 0.01).
Conclusions: The most important factors affecting prolonged LOS after MIVS were represented by age and redo surgery, although other preoperative characteristics such as reduced LVEF, NYHA class III or IV, and CKD play a significant role in delaying recovery after MIVS. Further larger studies are needed to better identify potential preoperative predictors of prolonged LOS after MIVS.
期刊介绍:
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery