paper of the week 2007 #24

JAMA — Abstract: Preoperative Hematocrit Levels and Postoperative Outcomes in Older Patients Undergoing Noncardiac Surgery, June 13, 2007, Wu et al. 297 (22): 2481

術前のヘマトクリット値の異常が手術後30日以内の患者の死亡のリスク因子であるという報告。

米国の在郷軍人病院のdatabaseを利用した研究
65歳以上の310 311の患者が対象
対象手術の数の多い順番best 20は以下の通り

Repair inguinal hernia
Prostatectomy
Rechanneling of artery
Total knee replacement
Partial removal of colon
Total hip replacement
Cystoscopy or resection of small bladder tumors
Repair of femur fracture (intertrochanteric, peritrochanteric, or subtrochanteric)
Leg amputation at thigh level
Repair of femur fracture, proximal end or neck
Cystoscopy or resection of medium bladder tumors
Laparoscopic cholecystectomy
Repair defect of artery
Exploration of abdomen
Partial removal of lung, single lobe
Cholecystectomy
Amputation of lower leg
Rerepair inguinal hernia
Repair abdominal hernia
Revision of hip prosthesis

結論は結構明快で
Ht<48%ではHtが低ければ低いほど死亡率が高かった ht>50%ではHtが高いほど死亡率が高かった

です。

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