Logistic Regression Analysis For Risk Factors Of Perioperative Mortality In Elderly Patients

Research background and objective:Population aging is a serious problem in current society.It aggravates the social burden and challenges the medical enterprise.The proportion of elderly patients during perioperative period has increased.Special physiological characters of elderly patients,such as the poor functional reserve of organs,simultaneous occurrence of multiple diseases,comtributes to greater risk of surgery and anesthesia and more postoperative adverse reactions,therefore,the perioperative mortality of elderly patients is higher than young and middle-aged patients.Hence,surgeons and anesthesiologists should focus on the ensurement of perioperative elderly patients safety and the reduction of perioperative mortality.Blood pressure,as one of the five human body vital signs,has been widely concerned during perioperative period.Real-time and effective blood pressure monitoring helps the anesthesiologist quickly assess the patient’s situation,and the maintenance of hemodynamics during intraoperative facilitate the clinical outcome of patients.Intraoperative hypotension is a common clinical phenomenon.Hypotension induced organ hypoperfusion may cause potential harm to elderly patients.However,the relationship between low blood pressure and duration and perioperative mortality in elderly patients remains unclear.This study aims to explore the correlation among perioperative mortality and intraoperative hypotension,duration of hypotension and other factors in elderly patients.It provides a theoretical basis for maintaining stable vital signs in elderly patients,thus optimizes the quality of anesthesia,reduces postoperative complications and perioperative mortality,and promotes early rehabilitation of elderly patients after surgery.Methods:1.Epidemiological characteristics of perioperative mortality in single-center elderly patients.From January 2007 to August 2017,156 cases of elderly patients at the age of 65 or above,belonging to The First Hospital Affiliated to AMU(Southwest Hospital),who died in-hospital after surgery have been collected.A variety of parameters have been recorded,such as gender,age,body mass index(BMI),department,operation time,ASA grade,cardiac function grade,anesthesia,anesthesia time,main clinical diagnosis and combined diagnosis(with or without hypotension,diabetes,coronary heart disease,cerebral hernia,arrhythmia,heart failure,respiratory failure,COPD,anemia,severe trauma,septic s hock,uncontrolled hemorrhagic shock,MODS,water electrolyte imbalances,end-stage tumor,coagulation dysfunction),surgical type,cause of death,postoperative survival time,postoperative catheterization time,whether PACU stays,whether vasoactive drugs are used,intraoperative blood loss,intraoperative urine volume,intraoperative blood transfusion volume.The perioperative mortality of elderly patients in single center has been calculated.The statistical description of perioperative death department,gender,age,causes of death have been analyzed.2.Logistic regression analysis of perioperative mortality related factors in single center elderly patientsFrom January 2007 to August 2017,156 cases of elderly patients at the age of 65 or above,belong to The First Hospital Affiliated to AMU(Southwest Hospital),who died in-hospital after surgery have been collected as the observation group.312 cases,collected from survival cases of elderly patients aged 65 years who underwent surgery in the same year,were randomly selected as the control group according to the ratio of 2:1(survival: death).All clinical indicators have been recorded.Meanwhile,the cumulative duration of SBP ≤ 80 mmHg,80mmHg < SBP ≤ 90 mmHg,90mmHg < SBP ≤ 100 mmHg,100mmHg < SBP ≤110mmHg,110 mmHg < SBP ≤120mmHg,SBP > 120 mmHg and MAP ≤ 55 mmHg,55mmHg < MAP ≤ 60 mmHg,60mmHg < MAP ≤ 65 mmHg,65mmHg < MAP ≤70mmHg,70 mmHg < MAP ≤75mmHg,MAP > 75 mmHg of the patients have also been recorded.Then,the ratio of the cumulative duration of blood pressure in different sections to the total anesthesia time was calculated.Univariate logistic regression analysis of perioperative clinical indicators in elderly patients is performed.Variables with P < 0.05 in the analysis results are selected for multivariate logistic regression analysis,and then the receiver operating characteristic(ROC)curve is plotted.3.Logistic regression analysis of perioperative death related factors in multi-center elderly patientsFrom September 2014 to March 2017,118 cases of elderly patients at the age of 65 or above,belong to The Hospital Affiliated to AMU(Southwest Hospital,Xinqiao Hospital)and Army characteristic medical center(Daping hospital),who died in-hospital after surgery have been collected as observation group.236 cases,collected from survival cases of elderly patients aged 65 years who underwent surgery in the same year in each hospital,were randomly selected as the control group according to the ratio of 2:1(survival: death).All clinical indicators have been recorded.Meanwhile,the cumulative duration of SBP ≤ 80 mmHg,80mmHg < SBP ≤90mmHg,90 mmHg < SBP ≤100mmHg,100 mmHg < SBP ≤ 110 mmHg,110mmHg < SBP ≤ 120 mmHg,SBP > 120 mmHg and MAP ≤55mmHg,55 mmHg < MAP≤ 60 mmHg,60mmHg < MAP ≤65mmHg,65 mmHg < MAP ≤70mmHg,70 mmHg < MAP ≤75mmHg,MAP > 75 mmHg of the patients have also been recorded.Then,the ratio of the cumulative duration of blood pressure in different sections to the total anesthesia time was calculated.Univariate Logistic Regression Analysis of Perioperative Clinical Indicators in Elderly Patients is performed.Variables with P< 0.05 in the analysis results are selected for multivariate logistic regression analysis,and then the receiver operating characteristic(ROC)curve is plotted.Results1.The average postoperative survival time of the elderly patients undergoing non-cardiac surgery was 11 days,and the perioperative mortality was 0.3%~0.7%.2.General department of hepatobiliary surgery,neurosurgery,general chest have the highest elderly patients perioperative mortality rate among all the clinical departments.With abdominal surgery as a reference,craniocerebral surgery is a high-risk factor for perioperative death in elderly patients.3.The main causes of perioperative death in elderly patients are infection,respiratory failure,MODS,and cerebral hernia.4.Intraoperative hypotension(MAP≤65mmHg)is a high risk factor for perioperative death of elderly patients(OR > 1),and it may be related to perioperative death of elderly patients when the cumulative total time exceeds 4.92~7.84% of the total operation time.5.Other risk factors that may be associated with perioperative mortality in elderly patients include age,ASA classification,general anesthesia,preoperative coronary heart disease,malignant tumors,COPD,intraoperative blood transfusion volume.Older patient,higher ASA grade,higher intraoperative blood transfusion volume and implementation of general anesthesia,preoperative coronary heart disease,malignant tumor and COPD would make higher risk of perioperative death for the elderly patients.PACU therapy is a protective factor for perioperative death in elderly patients.Conclusions1.Intraoperative hypotension(MAP≤65mmHg)was associated with perioperative death in elderly patients,and its cumulative duration accounted for 4.92~7.84% of the total operation time,which may increase the risk of perioperative death in elderly patients.2.Other factors that may be associated with perioperative mortality in elderly patients include age,ASA classification,general anesthesia,preoperative coronary heart disease,malignant tumor,COPD,craniocerebral surgery,intraoperative blood transfusion,and PACU therapy.