Vall d'Hebron University Hospital, Department of Anaesthesia, Autonoma University of Barcelona, Barcelona, Spain.
Br J Anaesth. 2011 Feb;106(2):189-93. doi: 10.1093/bja/aeq335. Epub 2010 Nov 25.
Nonagenarian population is growing, and so is the number of them needing emergency surgery. Yet, their treatment is often based on the outcomes of younger patients: although old age is known to be a risk factor for surgery, its level is not clear. This is a prospective, observational study to describe the population. It is aimed at providing quantified scientific evidence of the current procedures and their outcomes.
All non-traumatic nonagenarians who underwent surgery between July 2006 and September 2010 in our University Hospital were recruited and followed up over a month after discharge. A descriptive statistical analysis was performed.
Of the approximately 12 660 surgical emergencies, 102 were nonagenarians: 69.6% were women, who mostly had an ASA score III (62.7%). Perioperative morbidity and mortality rates of 61.6% [95% confidence interval (CI): 52.33-71.19%] and 35.3% (95% CI: 26.01-44.57%), respectively, were found statistically associated with preoperative neoplasms. The most frequent causes of surgery were acute limb arterial thrombosis (20), incarcerated hernia (17), and bowel occlusion (14). Confusion, renal failure, and abdominal problems accounted for the most frequent causes of morbidity. Among them, abdominal complications, cardiogenic pulmonary oedema, aspiration, stroke, and renal failure were associated with mortality.
The study gave scientific support and actual figures to many intuitive beliefs: morbidity and mortality are high and are associated with many preoperative comorbidities. All this, combined with an already reduced life expectancy, and a presumably low physiological reserve makes these patients particularly vulnerable to emergency surgery.
90 岁以上人口数量不断增加，需要接受急诊手术的人数也在增加。然而，他们的治疗通常基于年轻患者的结果：尽管已知老年是手术的一个风险因素，但具体程度尚不清楚。这是一项前瞻性、观察性研究，旨在描述这一人群。其目的是提供当前手术程序及其结果的量化科学证据。
我们招募了 2006 年 7 月至 2010 年 9 月期间在我们大学医院接受非创伤性 90 岁以上患者，并在出院后随访一个月。进行了描述性统计分析。
在大约 12660 例外科急症中，有 102 例为 90 岁以上患者：69.6%为女性，其中大多数美国麻醉医师协会（ASA）评分 III 级（62.7%）。围手术期发病率和死亡率分别为 61.6%（95%置信区间[CI]：52.33-71.19%）和 35.3%（95%CI：26.01-44.57%），均与术前肿瘤有关。手术最常见的原因是急性肢体动脉血栓形成（20 例）、嵌顿疝（17 例）和肠闭塞（14 例）。发病率最常见的原因是昏迷、肾衰竭和腹部问题。其中，腹部并发症、心源性肺水肿、吸入、中风和肾衰竭与死亡率相关。
该研究为许多直观的观点提供了科学支持和实际数据：发病率和死亡率都很高，并且与许多术前合并症相关。所有这些，再加上已经缩短的预期寿命和生理储备降低，使得这些患者在接受急诊手术时特别脆弱。
