八旬老人肺切除术后发病率模型。
A model for morbidity after lung resection in octogenarians.
机构信息
Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
出版信息
Eur J Cardiothorac Surg. 2011 Jun;39(6):989-94. doi: 10.1016/j.ejcts.2010.09.038. Epub 2011 Jan 26.
OBJECTIVE
Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians.
METHODS
A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method.
RESULTS
During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01).
CONCLUSIONS
Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in octogenarians being considered for lung resection.
目的
年龄是肺切除术后发病的一个重要危险因素。本研究旨在确定 80 岁以上患者肺切除术后并发症的具体危险因素。
方法
回顾性分析 2000 年 1 月至 2009 年 6 月在单中心接受肺切除术且年龄 80 岁及以上的患者的前瞻性数据库。评估术前、组织病理学、围手术期和转归变量。并发症发生率定义为患者发生了胸外科医师学会普通胸外科数据库定义的任何围手术期事件。使用一组既定的术前和手术变量建立并发症的多变量风险模型。采用 Kaplan-Meier 法计算生存率。
结果
研究期间，193 例 80 岁及以上患者（中位年龄 82 岁）接受了肺切除术：楔形切除术 77 例，节段切除术 13 例，肺叶切除术 96 例，双叶切除术 4 例，全肺切除术 3 例。149 例患者（77%）经胸腔镜完成手术。手术死亡率为 3.6%（7 例），并发症发生率为 46%（89 例）。181 例（94%）患者直接出院回家。术后事件包括心房颤动 38 例（20%）、持续性肺漏气 24 例（12%）、术后输血 22 例（11%）、意识模糊 16 例（8%）、需要支气管镜检查 14 例（7%）和肺炎 10 例（5%）。多变量分析显示，并发症的显著预测因素包括楔形切除术以外的肺切除术（比值比 2.98，p=0.006）、开胸手术作为手术方式（比值比 2.6，p=0.03）和预计用力呼气量占预计值的百分比（每下降 10%，比值比为 1.28，p=0.01）。
结论
80 岁以上患者可进行肺切除术，死亡率较低。切除范围、手术方式和肺功能受损会增加并发症的风险。在考虑对 80 岁以上患者进行肺切除术时，需要仔细评估以选择最合适的方法。
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