Objective To analyze the risk factors for complications in elderly patients with cardiac surgery under cardiopulmonary bypass.Methods From July 2004 to June 2012,64 patients aged ≥ 60 years undergoing cardiac operations were selected.Clinical data were collected.The complications after cardiac operation and the risk factors were evaluated by single factor analysis and multivariate Logistic regression analysis with SPSS software.Results The postoperative complication rate in all patients was 34.4％ (22/64).The complications occurred in 42 subjects and operative mortality was 6.3％ (4/64).The single factor analysis showed that chronic obstructive pulmonary disease combined before operation (P=0.001),diabetes combined before operation (P=0.009),cardiopulmonary bypass time ≥2 h (P=0.000),aortic cross clamping time ≥90min (P=0.001),and blood transfusion volume ≥2000 ml (P =0.000) were the important risk factors for postoperative complications.Multivariate Logistic regression analysis revealed that chronic obstructive pulmonary disease (P=0.007) and diabetes combined before operation (P=0.028),cardiopulmonary bypass time ≥2 h (P=0.003),and blood transfusion volume ≥2000 ml (P=0.030) were the significant independent predictive risk factors for postoperative complications.Conclusions Chronic obstructive pulmonary disease,diabetes,cardiopulmonary bypass time ≥2 h,aortic cross clamping time ≥90 min,and blood transfusion volume ≥2000 ml are the independent predictive risk factors for postoperative complications in elderly patients with cardiac surgery under cardiopulmonary bypass.

Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in perioperative period of laparoscopic sleeve gastrectomy (LSG).Method:The retrospective cohort study was conducted. The clinical data of 1 181 patients undergoing LSG in the Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from January 2021 to December 2023 were collected. There were 242 males and 939 females, aged (31±8)years. Of 1 181 patients, 598 cases receiving routine perioperative care were divided into the control group, and 583 cases receiving perioperative care with ERAS were divided into the ERAS group. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for comparison between the groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and the Mann-Whitney rank sum test was used for comparison between the groups. Count data were expressed as absolute numbers or percentages, and the chi-square test or Fisher exact probability were used for comparison between the groups. Repeated measurement data were analyzed using the repeated ANOVA, with baseline scores as covariates. Simple effects analysis was conducted in case of interaction, and multiple comparisons were adjusted using the Bonferroni method. Results:(1) Postoperative outcomes. The numerical rating scale (NRS) scores for pain at immediate return to the ward and on the third postoperative mornings changed from 5.35±0.93 to 2.57±0.83 in the control group, versus changed from 3.15±0.93 to 0.70±0.65 in the ERAS group, showing significant difference between the two groups ( Ftime=66.58, Fgroup=1 765.85, Finteraction=6.90, P<0.05). After adjusting NRS scores for pain at immediate return to the ward as the baseline, results of simple effects analysis showed that on the third postoperative mornings, the NRS scores in the ERAS group were lower by 1.89, 1.53, and 1.76 respectively compared to the control group ( P<0.05). Cases with nausea at immediate return to the ward and on the third postoperative mornings changed from 497 to 97 in the control group, versus changed from 198 to 11 in the ERAS group, showing signifi-cant difference between the two groups ( χ2=294.45, 398.76,209.39, 73.00, P<0.05). Cases with vomiting at immediate return to the ward and on the third postoperative mornings changed from 243 to 41 in the control group, versus changed from 51 to 2 in the ERAS group, showing significant difference between the two groups ( χ2=160.54, 149.37, 71.76, 35.69, P<0.05). The duration of postoperative hospital stay was (3.22±0.65)days in the control group, versus (2.17±0.49)days in the ERAS group, showing a significant difference between the two groups ( t=-11.89, P<0.05). (2) Complications. The incidence of cases with dehydration within postoperative 30 days was 0.50%(3/598) in the control group, versus 0.69%(4/583) in the ERAS group, showing no significant difference between the two groups ( P>0.05). None of patient in the control group and the ERAS group experienced bleeding, gastric leakage, intra-abdominal infection, and no patient had unplanned secondary surgery within postoperative 30 days. Conclusions:ERAS in perioperative period of LSG are safe and feasible. Compared to routine care, ERAS can significantly reduce postoperative pain, decrease the incidence of postoperative nausea and vomiting, shorten the postoperative hospital stay, and do not increase the rate of postoperative complications or unplanned secondary surgeries within postoperative 30 days.