研究:一般手术对孕妇是安全的


  【24drs.com】根据在线发表于5月13日JAMA Surgery期刊的一篇回溯世代研究,相较于未怀孕的妇女,孕妇进行一般手术后的术后并发症风险并没有显著差异。
  
  科罗拉多大学医学院外科的Hunter B. Moore医师等人写道,怀孕与身体体质、凝血、心血管、肺部、免疫系统之生理变化有关。这些变化对外科医师诊断治疗上有一定程度的挑战性,因为身体检查结果和实验室检测数值之间有所不同,因此,一般预期孕妇的术后并发症机率会比非孕妇患者增加。
  
  约有500分之一的孕妇需要非产科手术。之前比较孕妇和非孕妇在这类手术后的不良反应发生率的研究结果各异,研究者认为这或许是因为孕妇和非孕妇之间的差异因素校正不够,他们倾向用配对来克服这个研究障碍。
  
  使用2006年1月1日至2011年12月31日美国外科学院的国家手术质量改善计画参与者资料,研究者检视了手术的怀孕患者,并且根据63项术前特征,与接受一般外科医师进行相同手术的非孕妇者进行配对。
  
  配对之前,病患组包括2,764名孕妇,其中50.5%进行紧急的一般手术,另外,516,705名非孕妇,其中13.2%进行紧急的一般手术;相较于非孕妇,孕妇比较可能住院才进行手术(75.0% vs 59.7%),她们也比较年轻、比较少共病症,但是比较多异常的检验结果。
  
  使用倾向配对方法,研究者检视了2,539名孕妇和2,539名非孕妇,术前特征没有显著差异。
  
  30天时,孕妇和非孕妇有相似的死亡率(分别是0.4% vs 0.3%;P = .82)、整体发病率(6.6% vs 7.4%;P = .30),21人有术后并发症。
  
  研究限制包括:观察型研究设计,所以无法确认因果关系,另外缺乏胎儿结果的资料。
  
  研究作者表示,在此篇研究中并未将胎儿并发症纳入考量,其研究结果并不能一般化到可以延后到分娩后进行的特定手术状况;这些研究结果支持以前的报告,出现急性外科疾病的孕妇应进行手术,如果延误照护,病情将可能会恶化。
  
  资料来源:http://www.24drs.com/
  
  Native link:General Surgery Safe for Pregnant Women, Study Shows

General Surgery Safe for Pregnant Women, Study Shows

By Laurie Barclay, MD
Medscape Medical News

Compared with women who are not pregnant, those who are pregnant have no significant difference in postoperative complications after general surgery, according to a retrospective cohort study published online May 13 in JAMA Surgery.

"Pregnancy is associated with physiologic changes in body habitus and the coagulation, cardiovascular, pulmonary, and immune systems," write Hunter B. Moore, MD, from the Department of Surgery, School of Medicine, University of Colorado, Aurora, and colleagues. "These changes pose a diagnostic and treatment challenge to surgeons because physical examination findings and laboratory test values are different from those routinely encountered. Therefore, it might be expected that postoperative complications in pregnant patients are increased compared with those in nonpregnant patients."

Approximately 1 in 500 pregnant women require nonobstetric surgery. Findings from previous research comparing the occurrence of adverse outcomes after such surgery in pregnant vs nonpregnant women have been conflicting. The investigators suggest this may be because of insufficient adjustment for differences between pregnant and nonpregnant women, and they used propensity matching to overcome this obstacle.

Using the American College of Surgeons' National Surgical Quality Improvement Program participant user file from January 1, 2006, to December 31, 2011, the investigators identified pregnant surgical patients and matched them, on the basis of 63 preoperative characteristics, with nonpregnant women undergoing the same operations by general surgeons.

Before matching, the patient pool included 2764 pregnant women, of whom 50.5% had emergency general surgery, and 516,705 nonpregnant women, of whom 13.2% had emergency general surgery. Compared with nonpregnant women, pregnant women were more likely to have surgery in an inpatient setting (75.0% vs 59.7%). They were also younger, with fewer comorbidities but more abnormal laboratory test results.

Using propensity matching, the investigators identified 2539 pregnant and 2539 nonpregnant women with no meaningful differences in preoperative characteristics.

At 30 days, pregnant women and nonpregnant women had similar rates of mortality (0.4% vs 0.3%, respectively; P = .82), overall morbidity (6.6% vs 7.4%; P = .30), and 21 individual postoperative complications.

Limitations of this study include observational design, which precludes determination of causality and lack of data on fetal outcomes.

"We did not account for fetal complications in this study and would not advocate that our findings be generalized to elective surgical situations that can be postponed until after delivery," the study authors write. "These findings support previous reports that pregnant patients who present with acute surgical diseases should undergo the procedure if delay in definitive care will lead to progression of disease."

Funding from the Department of Surgery, Adult and Child Center for Health Outcomes Research and Delivery Science Joint Surgical Outcomes and Applied Research Program at the University of Colorado supported this study. The authors have disclosed no relevant financial relationships.

JAMA Surgery. Published online May 13, 2015.

    
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