年龄，ASA身体状况和手术结果：来自全国队列研究的见解。

IF 6.9 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia Pub Date : 2025-07-29 DOI:10.1111/anae.16723

Naima Kilhamn,Jesper Eriksson,Erik von Oelreich,Malin Jonsson Fagerlund,Anders Oldner,Emma Larsson

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引用次数: 0

摘要

随着全球每年进行超过3亿例外科手术，以及人口老龄化和并发症的增加，围手术期风险评估比以往任何时候都更加重要。虽然ASA身体状况被广泛用于评估手术风险，但在当代广泛的手术人群中，其与年龄的关系仍未得到充分探讨。本研究探讨成人手术队列中ASA身体状况、年龄和术后死亡率之间的关系。方法：这项全国性队列研究分析了2019年1月至2023年3月瑞典围手术期登记的年龄≥18岁的非心脏大手术患者的数据。有关合并症、社会经济因素和死亡率的数据从国家卫生登记处检索。主要终点为30天死亡率。次要结局是365天死亡率和30天在家存活天数。结果共分析了262938例择期手术和197108例急性手术，中位年龄分别为66岁和68岁。择期手术30天粗死亡率为1369(0.5%)，365天粗死亡率为10437（4.0%）。急性手术30天死亡率为10,602例（5.4%），365天死亡率为27,912例（14.2%）。30天死亡率的校正优势比（OR）表明，在择期手术（OR 13.7, 95%CI 7.5-25.0）和急性手术（OR 14.0, 95%CI 10.2-19.3）中，ASA身体状态3的风险比ASA身体状态1的风险增加14倍。相应地，ASA身体状态≥4与择期手术的优势比为62.2 （95%CI 33.5-115.5）和急性手术的优势比为51.1 （95%CI 37.1-70.3）相关。随着人口老龄化和手术需求的增加，像ASA身体状况这样的风险评估工具的持续评估是必不可少的。本研究显示ASA身体状况与当代成人手术队列中所有年龄段的死亡率之间存在很强的关联。这些发现可以增强我们对人口趋势变化背景下围手术期风险分层的理解。

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Age, ASA physical status and surgical outcomes: insights from a nationwide cohort study.

INTRODUCTION With over 300 million surgical procedures performed worldwide annually and an ageing population with increasing comorbidities, peri-operative risk assessment is more important than ever. Whilst the ASA physical status is used widely to assess surgical risk, its association with age remains underexplored in contemporary, broad surgical populations. This study examines the relationship between ASA physical status, age and postoperative mortality in an adult surgical cohort. METHODS This nationwide cohort study analysed data from the Swedish Perioperative Register on patients aged ≥ 18 y undergoing major non-cardiac surgery from January 2019 to March 2023. Data on comorbidities, socioeconomic factors and mortality were retrieved from national health registries. The primary outcome was 30-day mortality. Secondary outcomes were 365-day mortality and days at home alive at 30 days. RESULTS A total of 262,938 elective and 197,108 acute procedures were analysed, with median ages of 66 and 68 y, respectively. Crude mortality rates in elective surgery were 1369 (0.5%) at 30 days and 10,437 (4.0%) at 365 days. For acute surgery, mortality was 10,602 (5.4%) at 30 days and 27,912 (14.2%) at 365 days. Adjusted odds ratios (OR) for 30-day mortality indicated a 14-fold increased risk for ASA physical status 3 compared with ASA physical status 1 in both elective (OR 13.7, 95%CI 7.5-25.0) and acute (OR 14.0, 95%CI 10.2-19.3) surgeries. Correspondingly, ASA physical status ≥ 4 was associated with odds ratios of 62.2 (95%CI 33.5-115.5) for elective and 51.1 (95%CI 37.1-70.3) for acute surgery. DISCUSSION As populations age and surgical demand increases, continuous evaluation of risk assessment tools like the ASA physical status is essential. This study shows a strong association between ASA physical status and mortality across all ages in a contemporary adult surgical cohort. These findings could enhance our understanding of peri-operative risk stratification in the context of shifting demographic trends.

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来源期刊

Anaesthesia 医学-麻醉学

CiteScore

21.20

自引率

9.30%

发文量

300

审稿时长

6 months

期刊介绍： The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.