Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania, USA.
Dis Colon Rectum. 2011 Apr;54(4):467-71. doi: 10.1007/DCR.0b013e3182060904.
There are few reports of long-term outcomes in elderly patients after open colectomy.
This study aimed to determine the in-hospital and 6-month outcomes and identify the variables associated with mortality after colectomy in patients ≥ 80 years of age.
The charts of patients ≥ 80 years of age, who underwent open colectomy, were analyzed. Data included indications for operation, underlying diagnoses, preoperative functional status, type of procedure, length of procedure, length of stay, ASA grade, complications, and in-hospital and 6-month mortality rates. Univariate and multivariate logistic regression analyses were conducted to ascertain risk factors for mortality. P values of < .05 were considered significant.
The main outcome measures were in-hospital and 6-month mortality.
One hundred sixty-two patients ≥ 80 years of age underwent colectomy: 99 patients emergently; 63, electively. Postoperative acute renal failure (3% vs 19%, P = .0032) and in-hospital deaths were significantly higher (4.7% vs 28%, P = .0002) among the patients undergoing emergent colectomies. The mortality rate among emergent cases rose from 28% in-hospital to 52% at 6 months. Mortality among the elective cases increased similarly from 4.7% to 28.5%. Admission from a nursing facility was associated with higher in-hospital mortality (47.6% vs 14.9%, P = .0005). Discharge to a skilled nursing facility was associated with a higher 6-month mortality rate compared with discharge to home (40% vs 17%). Length of procedure, postoperative complications, perioperative blood transfusion, and emergent indications for operation independently predicted in-hospital mortality. Postoperative complications and emergent diagnosis independently predicted 6-month mortality. The 6-month mortality rate varied according to the underlying diagnosis as follows: fulminant Clostridium difficile colitis (86%); ischemic colitis (60%); gastrointestinal bleeding (37%), and volvulus (40%).
This study was limited by its retrospective nature.
Emergent open colectomy in elderly patients is associated with a high morbidity and mortality rate. The mortality rate rises by >20% in both elective and emergent cases at discharge to 6 months. Length of procedure, postoperative complications, and colectomy for emergent indications predicted mortality.
有关高龄患者开腹结肠切除术后长期结局的报道较少。
本研究旨在确定 80 岁以上患者开腹结肠切除术后住院和 6 个月的结局，并确定与死亡率相关的变量。
分析了 80 岁以上接受开腹结肠切除术的患者的病历。数据包括手术适应证、基础诊断、术前功能状态、手术类型、手术时间、住院时间、ASA 分级、并发症以及住院和 6 个月死亡率。进行单变量和多变量逻辑回归分析以确定死亡率的危险因素。P 值<0.05 被认为具有统计学意义。
主要观察指标为住院和 6 个月死亡率。
162 例 80 岁以上患者行结肠切除术：99 例急诊手术；63 例择期手术。术后急性肾衰竭（3%比 19%，P=0.0032）和住院期间死亡率（4.7%比 28%，P=0.0002）显著更高。急诊手术患者的住院期间死亡率从 28%上升至 6 个月时的 52%。择期手术患者的死亡率从 4.7%上升至 28.5%。从疗养院入院与更高的住院期间死亡率相关（47.6%比 14.9%，P=0.0005）。与出院回家相比，出院至康复护理机构与更高的 6 个月死亡率相关（40%比 17%）。手术时间、术后并发症、围手术期输血以及急诊手术适应证独立预测住院期间死亡率。术后并发症和急诊诊断独立预测 6 个月死亡率。6 个月死亡率因基础诊断而异，如下：暴发性艰难梭菌结肠炎（86%）；缺血性结肠炎（60%）；胃肠道出血（37%）和肠扭转（40%）。
本研究受到其回顾性的限制。
高龄患者的急诊开腹结肠切除术与较高的发病率和死亡率相关。在出院至 6 个月期间，选择性和急诊手术的死亡率均升高超过 20%。手术时间、术后并发症和因急诊适应证行结肠切除术预测死亡率。
