甲状腺成形术和类蝶关节内收术后气道并发症的危险因素。

IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY
Keisuke Kondo, Ryuhei Okada, Keiji Honda, Takahiro Asakage, Takeshi Tsutsumi, Kiyohide Fushimi, Daisuke Shinjo
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引用次数: 0

摘要

重要性:甲状腺成形术和杓状内收是常见的声音外科手术,通常并发症发生率低。然而,尽管罕见,气道并发症可危及生命,危险因素尚不清楚。目的:评价甲状腺成形术和类甲状腺内收术后14天内气道阻塞和死亡的短期风险,并确定可改变的危险因素。设计、环境和参与者:本队列研究使用来自日本诊断程序组合数据库的数据,从2010年7月至2021年12月接受甲状腺成形术或杓状内收的患者中确定符合条件的参与者。采用多元回归和时变Cox回归评估危险因素。数据分析时间为2024年9月至2025年4月。暴露:甲状腺成形术和类甲状腺内收及潜在危险因素,包括抗血小板使用、胃食管反流疾病、慢性肺部疾病和外科手术。主要结局和措施:气管切开术、气管插管或术后14天内死亡。结果:共纳入8626例患者(平均[SD]年龄60.2[16.2]岁;女性3127例(36.3%),男性5499例(63.7%)),其中总并发症发生率2.03%,死亡率0.13%。多变量分析显示,高龄患者发生气道并发症的风险有临床意义的增加;手术过程的复杂性(杓状内收和III型和IV型甲状腺成形术);持续使用抗血小板药物(调整后相对危险度[aRR], 3.49;95% ci, 1.28-9.54);抗血小板恢复(aRR, 2.86;95% CI, 0.89-9.19)或术后第1天使用抗凝剂(aRR, 3.20;95% ci, 0.77-13.25);存在慢性阻塞性肺疾病;转移性癌症。结论及意义:这些发现表明,对慢性肺部疾病患者进行适当的抗凝和抗血小板治疗,以及术前风险评估和围手术期气道管理可能有助于降低甲状腺成形术和类甲状腺内收后短期气道并发症的风险。个体化风险管理的患者接受甲状腺成形术和类甲状腺内收是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk Factors for Airway Complications After Thyroplasty and Arytenoid Adduction.

Importance: Thyroplasty and arytenoid adduction are common phonosurgical procedures that generally have low complication rates. However, although rare, airway complications can be life-threatening, and the risk factors remain unclear.

Objective: To evaluate the short-term risks of airway obstruction and death within 14 days postoperatively associated with thyroplasty and arytenoid adduction, and to identify modifiable risk factors.

Design, setting, and participants: This cohort study used data from the Japanese Diagnosis Procedure Combination database to identify eligible participants from among the patients who underwent thyroplasty or arytenoid adduction from July 2010 to December 2021. Multiple regression and time-dependent Cox regression were used to assess risk factors. Data were analyzed from September 2024 to April 2025.

Exposure: Thyroplasty and arytenoid adduction and potential risk factors, including antiplatelet use, gastroesophageal reflux disease, chronic pulmonary disease, and surgical procedures.

Main outcomes and measures: Tracheostomy, tracheal intubation, or death within 14 days postoperatively.

Results: The analysis included 8626 patients (mean [SD] age, 60.2 [16.2] years; 3127 female [36.3%] and 5499 male [63.7%]), among whom the overall complication rate was 2.03% and the mortality rate, 0.13%. Multivariable analysis showed a clinically meaningful increase in the risk of airway complications associated with advanced age; complexity of the surgical procedure (arytenoid adduction and type III and IV thyroplasty); continuous use of antiplatelets (adjusted relative risk [aRR], 3.49; 95% CI, 1.28-9.54); resumption of antiplatelets (aRR, 2.86; 95% CI, 0.89-9.19) or anticoagulants on postoperative day 1 (aRR, 3.20; 95% CI, 0.77-13.25); presence of chronic obstructive pulmonary disease; and metastatic cancer.

Conclusions and relevance: These findings indicate that appropriate management of anticoagulant and antiplatelet therapy, as well as preoperative risk assessment and perioperative airway management for patients with chronic pulmonary disease may help reduce the risk of short-term airway complications after thyroplasty and arytenoid adduction. Individualized risk management in patients undergoing thyroplasty and arytenoid adduction is needed.

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来源期刊
CiteScore
9.10
自引率
5.10%
发文量
230
期刊介绍: JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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