Ballotta Enzo, Da Giau Giuseppe, Militello Carmelo, Terranova Oreste, Piccoli Antonio
Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padua, Italy.
Ann Vasc Surg. 2007 Nov;21(6):772-9. doi: 10.1016/j.avsg.2007.04.005. Epub 2007 May 29.
Although major vascular surgery is performed with increasing frequency in elderly people, the impact of age on outcomes is uncertain. We evaluated the perioperative (30-day) outcomes for patients who underwent major elective vascular operations under general or peripheral anesthesia in their eighties and nineties in a 14-year period. Data for all consecutive 3,060 patients (456 of them > or years old) who underwent 3,314 elective vascular surgery procedures were prospectively entered into a computerized vascular registry. Detailed information was collected on patients' preoperative status, type of procedure and anesthesia, perioperative outcomes, and predictors of perioperative outcomes. The end points of the study were perioperative death and main surgical complications. Perioperative all-cause mortality rates varied across operations and were higher in elderly than in younger patients (1.4% vs. 0.2%, P = 0.014) after abdominal surgery (2.4% vs. 0.1%, P = 0.006) and especially after abdominal aortic aneurysm repair (2.8% vs. 0%, P = 0.035). In the elderly cohort, the mortality rate was <1% for almost 60% of all operations. In logistic regression analysis, only preoperative hypertension (odds ratio [OR] = 72.5, 95% confidence interval [CI] 9.4-557.6), congestive heart failure (OR = 16.5, 95% CI 2.3-115.9), and perioperative cardiac (OR = 20.7, 95% CI 1.6-273.8) and pulmonary (OR = 41.7, 95% CI 7.9-218.9) complications were associated with a higher 30-day death risk. In this series, perioperative outcomes were not influenced by the type of elective surgical procedure. Though overall mortality after major vascular surgery was higher in patients > or 80 years old, age per se was not an independent factor of a higher perioperative mortality risk or fatal and nonfatal complications.
尽管大型血管手术在老年人中的实施频率越来越高，但年龄对手术结果的影响尚不确定。我们评估了在14年期间，八九十岁的患者在全身麻醉或外周麻醉下接受大型择期血管手术的围手术期（30天）结果。对所有连续接受3314例择期血管外科手术的3060例患者（其中456例年龄在80岁及以上）的数据进行前瞻性录入计算机化血管登记系统。收集了患者术前状况、手术和麻醉类型、围手术期结果以及围手术期结果预测因素的详细信息。研究的终点是围手术期死亡和主要手术并发症。围手术期全因死亡率因手术而异，腹部手术后老年患者高于年轻患者（1.4%对0.2%，P = 0.014），腹主动脉瘤修复术后更高（2.4%对0.1%，P = 0.006），尤其是腹主动脉瘤修复术后（2.8%对0%，P = 0.035）。在老年队列中，几乎60%的手术死亡率<1%。在逻辑回归分析中，只有术前高血压（比值比[OR]=72.5，95%置信区间[CI]9.4 - 557.6）、充血性心力衰竭（OR = 16.5，95%CI 2.3 - 115.9）以及围手术期心脏（OR = 20.7，95%CI 1.6 - 273.8）和肺部（OR = 41.7，95%CI 7.9 - 218.9）并发症与30天死亡风险较高相关。在本系列研究中，围手术期结果不受择期手术类型的影响。虽然80岁及以上患者接受大型血管手术后的总体死亡率较高，但年龄本身并不是围手术期死亡风险或致命及非致命并发症较高的独立因素。
