Story David A
Department of Anaesthesia, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.
Curr Opin Anaesthesiol. 2008 Jun;21(3):375-9. doi: 10.1097/ACO.0b013e3282f889f8.
To outline perioperative risk factors for postoperative mortality in older patients, the relationship of these factors with long-term mortality, and to examine possible strategies to reduce mortality.
For patients aged 70 years and over 30-day mortality is about 6%, whereas 20% are likely to have at least one complication during their hospital stay. The mortality risk increases by 10% for every year after age 70. Mortality is also strongly associated with preoperative status and postoperative complications, particularly systemic inflammation and renal impairment. Unplanned postoperative intensive care unit admission is an important predictor for mortality. Requirement for postoperative vasopressors or inotropes is associated with 50% mortality in patients aged 80 years or more. Early postoperative complications are likely to be associated with an increased long-term (a year or more later) mortality. Strategies such as critical care outreach may decrease both 30-day and long-term mortality.
Strategies are needed to prevent, or at least adequately manage, complications in elderly patients. Agreed international definitions for risks and complications can help in assessing risks and benefits.
概述老年患者术后死亡的围手术期风险因素、这些因素与长期死亡率的关系，并探讨降低死亡率的可能策略。
70岁及以上患者的30天死亡率约为6%，而20%的患者在住院期间可能至少发生一种并发症。70岁以后，死亡率每年增加10%。死亡率还与术前状态和术后并发症密切相关，尤其是全身炎症和肾功能损害。术后非计划性重症监护病房入住是死亡的重要预测因素。80岁及以上患者术后需要血管升压药或正性肌力药物与50%的死亡率相关。术后早期并发症可能与长期（一年或更晚）死亡率增加有关。重症监护外展等策略可能会降低30天和长期死亡率。
需要采取策略来预防或至少充分管理老年患者的并发症。商定的国际风险和并发症定义有助于评估风险和益处。
