Rubinfeld Ilan, Thomas Casey, Berry Stepheny, Murthy Raghav, Obeid Nadia, Azuh Oguchukwu, Jordan Jack, Patton Joe H
Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA.
J Trauma. 2009 Nov;67(5):983-9. doi: 10.1097/TA.0b013e3181ad6690.
As the aging population continues to increase, the surgical needs of the elderly will increase. The acute care surgery model has been developed in which the trauma team also manages all general surgical emergencies to improve patient outcomes. We retrospectively reviewed our elderly acute care surgery population during the past 5 years to determine the variables affecting major abdominal surgery outcomes.
Patients aged 80 years and older who received an emergent major abdominal operation by our Acute Care Surgery team between July 2000 and November 2006 were included. We assessed after-hours operations, length of stay, duration of operation, gender, comorbidities, and mortality. Administrative, operating room, and corporate databases were used for demographics, comorbidities, admission logistics, American Society of Anesthesiologists (ASA) score, and mortality. We performed SPSS, chi2, and logistic regression analyses.
A total of 183 operations were performed with a mortality of 15%. Significant predictors were ASA score and female gender, with increasing ASA scores leading to worse outcomes and women faring worse than men as an independent variable. Neither operative duration nor off-hours surgery was associated with increased mortality.
This is the first study to report mortality data and expected survival curves for major abdominal surgery in the octogenarian population. Our data prove that it is safer than previously thought to operate on the elderly. Our mortality data and survival curves provide real data for the surgeon to be able to risk stratify and discuss predicted outcomes with consultants, patients, and families.
随着老龄化人口持续增加，老年人的手术需求也会上升。已发展出急性护理手术模式，即创伤团队也负责处理所有普通外科急症，以改善患者预后。我们回顾性分析了过去5年里接受急性护理手术的老年患者群体，以确定影响腹部大手术预后的变量。
纳入2000年7月至2006年11月间由我们的急性护理手术团队进行急诊腹部大手术的80岁及以上患者。我们评估了非工作时间手术、住院时间、手术时长、性别、合并症及死亡率。利用行政、手术室及公司数据库获取人口统计学资料、合并症、入院后勤情况、美国麻醉医师协会（ASA）评分及死亡率。我们进行了SPSS分析、卡方检验及逻辑回归分析。
共进行了183例手术，死亡率为15%。显著的预测因素为ASA评分及女性性别，ASA评分越高预后越差，且作为独立变量，女性的预后比男性更差。手术时长及非工作时间手术均与死亡率增加无关。
这是第一项报告八旬老人腹部大手术死亡率数据及预期生存曲线的研究。我们的数据证明，对老年人进行手术比之前认为的更安全。我们的死亡率数据及生存曲线为外科医生提供了实际数据，使其能够进行风险分层，并与会诊医生、患者及家属讨论预测结果。
