研究:一般手術對孕婦是安全的


  【24drs.com】根據線上發表於5月13日JAMA Surgery期刊的一篇回溯世代研究,相較於未懷孕的婦女,孕婦進行一般手術後的術後併發症風險並沒有顯著差異。
  
  科羅拉多大學醫學院外科的Hunter B. Moore醫師等人寫道,懷孕與身體體質、凝血、心血管、肺部、免疫系統之生理變化有關。這些變化對外科醫師診斷治療上有一定程度的挑戰性,因為身體檢查結果和實驗室檢測數值之間有所不同,因此,一般預期孕婦的術後併發症機率會比非孕婦患者增加。
  
  約有500分之一的孕婦需要非產科手術。之前比較孕婦和非孕婦在這類手術後的不良反應發生率的研究結果各異,研究者認為這或許是因為孕婦和非孕婦之間的差異因素校正不夠,他們傾向用配對來克服這個研究障礙。
  
  使用2006年1月1日至2011年12月31日美國外科學院的國家手術品質改善計畫參與者資料,研究者檢視了手術的懷孕患者,並且根據63項術前特徵,與接受一般外科醫師進行相同手術的非孕婦者進行配對。
  
  配對之前,病患組包括2,764名孕婦,其中50.5%進行緊急的一般手術,另外,516,705名非孕婦,其中13.2%進行緊急的一般手術;相較於非孕婦,孕婦比較可能住院才進行手術(75.0% vs 59.7%),她們也比較年輕、比較少共病症,但是比較多異常的檢驗結果。
  
  使用傾向配對方法,研究者檢視了2,539名孕婦和2,539名非孕婦,術前特徵沒有顯著差異。
  
  30天時,孕婦和非孕婦有相似的死亡率(分別是0.4% vs 0.3%;P = .82)、整體發病率(6.6% vs 7.4%;P = .30),21人有術後併發症。
  
  研究限制包括:觀察型研究設計,所以無法確認因果關係,另外缺乏胎兒結果的資料。
  
  研究作者表示,在此篇研究中並未將胎兒併發症納入考量,其研究結果並不能一般化到可以延後到分娩後進行的特定手術狀況;這些研究結果支持以前的報告,出現急性外科疾病的孕婦應進行手術,如果延誤照護,病情將可能會惡化。
  
  資料來源: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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