Peled Eli, Keren Yaniv, Halachmi Sarel, Soudry Michael, Zinman Chaim, Kats Yeshayahu, Barak Michal
Department of Orthopedic Surgery B, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Gerontology. 2009;55(5):517-22. doi: 10.1159/000235617. Epub 2009 Aug 14.
The population is progressively aging and an increasing number of elderly patients face surgical treatment.
The current study was designed to examine the perioperative morbidity and mortality of elderly patients undergoing orthopedic or urologic surgery and look for predictors for adverse outcome.
This is a prospective study of elderly patients, 80 years of age and older, who underwent elective or emergent orthopedic or urologic surgery in our institution during a 5-month period. Data were collected on age, gender, chronic diseases, number of regular medications, whether or not the patient was bedridden before surgery, American Society of Anesthesiologists (ASA) class, type of surgery and anesthesia, duration of hospitalization, and 30-day postoperative morbidity and mortality. We studied correlations between pre- and intraoperative parameters and postoperative complications.
During the study period, 39 patients underwent urologic surgery and 147 patients underwent orthopedic surgery. Age ranged from 80 to 98 years (85 +/- 4.2 years, mean +/- SD). One patient had an intraoperative complication, 5 patients had postoperative complications within 1 day of surgery, and 23 had complications within 1 month of surgery. Five (2.7%) patients, all of whom were operated urgently, died after surgery. Postoperative complications correlated significantly to poor ASA class (p = 0.01), urgency of the procedure (p = 0.03), and extent (p = 0.02) and duration (p = 0.01) of surgery. No significant correlation was found between outcome and any other pre- or intraoperative factors.
Elderly surgical patients with poor ASA class or following urgent, extensive or long surgery are at a higher risk for postoperative morbidity and mortality, mandating special perioperative care.
人口老龄化进程不断加快，越来越多的老年患者需要接受外科治疗。
本研究旨在探讨接受骨科或泌尿外科手术的老年患者围手术期的发病率和死亡率，并寻找不良结局的预测因素。
这是一项针对80岁及以上老年患者的前瞻性研究，这些患者在5个月内于我院接受了择期或急诊骨科或泌尿外科手术。收集的数据包括年龄、性别、慢性病、常规用药数量、术前是否卧床、美国麻醉医师协会（ASA）分级、手术和麻醉类型、住院时间以及术后30天的发病率和死亡率。我们研究了术前和术中参数与术后并发症之间的相关性。
在研究期间，39例患者接受了泌尿外科手术，147例患者接受了骨科手术。年龄范围为80至98岁（平均85±4.2岁，均值±标准差）。1例患者出现术中并发症，5例患者在术后1天内出现术后并发症，23例患者在术后1个月内出现并发症。5例（2.7%）患者均为急诊手术，术后死亡。术后并发症与ASA分级差（p = 0.01）、手术紧急程度（p = 0.03）、手术范围（p = 0.02）和手术持续时间（p = 0.01）显著相关。未发现结局与任何其他术前或术中因素之间存在显著相关性。
ASA分级差或接受急诊、大型或长时间手术的老年外科患者术后发病率和死亡率较高，需要特殊的围手术期护理。
