Risk factors for prolonged length of stay in post-anesthesia care unit and development of a prediction model in patients undergoing radical esophagectomy
Risk factors for prolonged length of stay in post-anesthesia care unit and development of a prediction model in patients undergoing radical esophagectomy
李冰 1刘瑶 2刘新民 1赵影 1张加强 1张伟 1周晓云
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作者信息
1. 河南省人民医院 (郑州大学人民医院)麻醉与围术期医学科，郑州 450003
2. 郑州人民医院麻醉科，郑州 450003
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摘要
目的 筛选全麻食管癌根治术患者麻醉恢复室停留时间(PACU-LOS)延长的危险因素并建立预测模型。 方法 选取2019年1月至2020年12月本院全麻食管癌根治术后带气管插管转入PACU患者的临床资料，性别不限，年龄40～80岁，ASA分级Ⅰ-Ⅲ级。收集患者年龄、性别、ASA分级、吸烟史、饮酒史、非胸外科手术史、高血压史、糖尿病史、术前贫血、呼吸系统疾病、麻醉药物剂量、术前神经阻滞情况、术中阿片类药物和右美托咪定用量、手术方式(开胸/腔镜)、手术时间、血管药物使用情况、心动过缓和低血压发生情况、红细胞输注量、血浆输注量、总输液量、出血量、尿量。收集PACU气管拔管时间、气管拔管后10 min静态VAS评分、PACU期间补救镇痛药物用量、气管拔管后低氧血症和恶心呕吐发生情况。根据PACU-LOS将患者分为PACU-LOS正常组(PACU-LOS≤2 h)和PACU-LOS延长组(PACU-LOS>2 h)。采用logistic回归模型筛选PACU-LOS延长的危险因素，建立预测模型并进行验证，采用受试者工作特征曲线评估模型区分度，采用Hosmer-Lemshow拟合度检验评估模型一致性。 结果 本研究共纳入943例患者，术后PACU-LOS延长发生率15.7%。logistic回归分析显示，慢性阻塞性肺疾病病史(OR＝4.900，95%CI 2.512～9.556)、年龄65～74岁(OR＝22.154，95%CI 6.736～73.003)、气管拔管时间延长(OR＝1.214，95%CI 1.174～1.256)和气管拔管后低氧血症(OR＝4.891，95%CI 2.167～11.039)是全麻食管癌根治术患者PACU-LOS延长的危险因素(P<0.05)；术前神经阻滞(OR＝0.358，95%CI 0.190～0.672)是食管癌根治患者PACU-LOS延长的保护因素(P<0.05)。预测模型的受试者工作特征曲线下面积为0.947(95%CI 0.925～0.963)，灵敏度为0.878，特异度为0.906；采用验证集对预测模型进行受试者工作特征曲线内部验证，曲线下面积为0.942(95%CI 0.895～0.942，P<0.001)，约登指数为0.784。列线图预测模型经Hosmer-Lemshow检验，P<0.001，可视化列线图模型C指数为0.946。 结论 术前合并慢性阻塞性肺疾病、年龄增加、气管拔管时间延长和拔管后低氧血症是PACU-LOS延长的危险因素；术前神经阻滞是保护因素；基于此建立的风险预测模型可有效预测全麻食管癌根治术患者PACU-LOS延长的发生。 Objective To identify the risk factors for prolonged length of stay in post-anesthesia care unit (PACU-LOS) and development of a prediction model in the patients undergoing radical esophagectomy. Methods The medical records from patients of both sexes, aged 40-80 yr, of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ, transferred to PACU with tracheal intubation after radical esophagectomy under general anesthesia in our hospital from January 2019 to December 2020, were retrospectively collected. The patient′s age, gender, American Society of Anesthesiologists Physical Status classification, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, preoperative anemia, respiratory diseases, doses of anesthetics, preoperative nerve block, intraoperative consumption of opioids and dexmedetomidine, operation method (thoracotomy and endoscopic surgery), operation time, usage of vascular drugs, bradycardia, hypotension, red blood cell infusion, plasma infusion, total infusion volume, blood loss and urine volume were collected. The extubation time in PACU, visual analog scale scores at rest at 10 min after extubation, consumption of rescue analgesics in PACU, hypoxemia after extubation, and occurrence of nausea and vomiting were also collected. Patients were divided into PACU-LOS normal group (PACU-LOS≤2 h) and PACU-LOS prolonged group (PACU-LOS>2 h) according to the PACU-LOS. Logistic regression analysis was used to identity the risk factors for prolonged PACU-LOS in the patients undergoing radical esophagectomy, and the predictive model was established and verified. The receiver operating characteristic curves were used to evaluate the model discrimination and Hosmer-Lemshow goodness-of-fit test was used to evaluate the consistency of the model. Results A total of 943 patients were included in this study, and the incidence of prolonged PACU-LOS was 15.7%. The results of logistic regression analysis showed that chronic obstructive pulmonary disease (OR=4.900, 95% confidence interval [CI] 2.512-9.556), increasing age (OR=22.154, 95% CI 6.736-73.003), prolonged time of extubation (OR=1.214, 95% CI 1.174-1.256) and hypoxemia after extubation (OR=4.891, 95% CI 2.167-11.039) were risk factors for prolonged PACU-LOS, and the preoperative use of nerve block (OR=0.358, 95% CI 0.190-0.672) was a protective factor for prolonged PACU-LOS in the patients undergoing radical esophagectomy (P<0.05). The area under the receiver operating characteristic curve (95%CI) was 0.947 (0.925-0.963), the sensitivity was 0.878, and the specificity was 0.906. The internal validation of the prediction model was carried out using the receiver operating characteristic curve in the validation set, and the area under the curve (95% CI) was 0.942 (0.895-0.942, P<0.001) and the Youden index was 0.784. The line chart prediction model was developed. The prediction analysis model was verified by Hosmer-Lemshow test,P<0.001, and the C-index visualized line chart prediction model was 0.946. Conclusions Preoperative chronic obstructive pulmonary disease, increasing age, prolonged time of extubation and hypoxemia after extubation are risk factors for prolonged PACU-LOS, and preoperative use of nerve block is a protective factor for prolonged PACU-LOS. The risk prediction model developed can effectively predict the occurrence of prolonged PACU-LOS in the patients undergoing radical esophagectomy.
Abstract
Objective To identify the risk factors for prolonged length of stay in post-anesthesia care unit (PACU-LOS) and development of a prediction model in the patients undergoing radical esophagectomy. Methods The medical records from patients of both sexes, aged 40-80 yr, of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ, transferred to PACU with tracheal intubation after radical esophagectomy under general anesthesia in our hospital from January 2019 to December 2020, were retrospectively collected. The patient′s age, gender, American Society of Anesthesiologists Physical Status classification, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, preoperative anemia, respiratory diseases, doses of anesthetics, preoperative nerve block, intraoperative consumption of opioids and dexmedetomidine, operation method (thoracotomy and endoscopic surgery), operation time, usage of vascular drugs, bradycardia, hypotension, red blood cell infusion, plasma infusion, total infusion volume, blood loss and urine volume were collected. The extubation time in PACU, visual analog scale scores at rest at 10 min after extubation, consumption of rescue analgesics in PACU, hypoxemia after extubation, and occurrence of nausea and vomiting were also collected. Patients were divided into PACU-LOS normal group (PACU-LOS≤2 h) and PACU-LOS prolonged group (PACU-LOS>2 h) according to the PACU-LOS. Logistic regression analysis was used to identity the risk factors for prolonged PACU-LOS in the patients undergoing radical esophagectomy, and the predictive model was established and verified. The receiver operating characteristic curves were used to evaluate the model discrimination and Hosmer-Lemshow goodness-of-fit test was used to evaluate the consistency of the model. Results A total of 943 patients were included in this study, and the incidence of prolonged PACU-LOS was 15.7%. The results of logistic regression analysis showed that chronic obstructive pulmonary disease (OR=4.900, 95% confidence interval [CI] 2.512-9.556), increasing age (OR=22.154, 95% CI 6.736-73.003), prolonged time of extubation (OR=1.214, 95% CI 1.174-1.256) and hypoxemia after extubation (OR=4.891, 95% CI 2.167-11.039) were risk factors for prolonged PACU-LOS, and the preoperative use of nerve block (OR=0.358, 95% CI 0.190-0.672) was a protective factor for prolonged PACU-LOS in the patients undergoing radical esophagectomy (P<0.05). The area under the receiver operating characteristic curve (95%CI) was 0.947 (0.925-0.963), the sensitivity was 0.878, and the specificity was 0.906. The internal validation of the prediction model was carried out using the receiver operating characteristic curve in the validation set, and the area under the curve (95% CI) was 0.942 (0.895-0.942, P<0.001) and the Youden index was 0.784. The line chart prediction model was developed. The prediction analysis model was verified by Hosmer-Lemshow test,P<0.001, and the C-index visualized line chart prediction model was 0.946. Conclusions Preoperative chronic obstructive pulmonary disease, increasing age, prolonged time of extubation and hypoxemia after extubation are risk factors for prolonged PACU-LOS, and preoperative use of nerve block is a protective factor for prolonged PACU-LOS. The risk prediction model developed can effectively predict the occurrence of prolonged PACU-LOS in the patients undergoing radical esophagectomy.
关键词
苏醒室/住院时间/食管癌/食管切除术/危险因素/预测
Key words
Resuscitation room/Length of stay/Esophageal cancer/Esophagectomy/Risk factors/Forecasting
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