年龄很重要：一项针对美国老年人群行胆囊切除术的临床和经济结局的研究。

Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans.

机构信息

Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA.

出版信息

Am J Surg. 2011 Jun;201(6):789-96. doi: 10.1016/j.amjsurg.2010.04.018.

DOI:10.1016/j.amjsurg.2010.04.018

PMID:21741511

Abstract

BACKGROUND

Gallstone disease increases with age. The aims of this study were to measure short-term outcomes from cholecystectomy in hospitalized elderly patients, assess the effect of age, and identify predictors of outcomes.

METHODS

This was a cross-sectional analysis, using the Health Care Utilization Project Nationwide Inpatient Sample (1999-2006), of elderly patients (aged 65-79 and ≥80 years) and a comparison group (aged 50-64 years) hospitalized for cholecystectomy. Linear and logistic regression models were used to evaluate age and outcome relationships. Main outcomes were in-hospital mortality, complications, discharge disposition, mean length of stay, and cost.

RESULTS

A total of 149,855 patients aged 65 to 79 years, 62,561 patients aged ≥ 80 years, and 145,675 subjects aged 50 to 64 years were included. Elderly patients had multiple biliary diagnoses and longer times to surgery from admission and underwent more open procedures. Patients aged 65 to 79 years and those aged ≥80 years had higher adjusted odds of mortality (odds ratios [ORs], 2.36 and 5.91, respectively), complications (ORs, 1.57 and 2.39), nonroutine discharge (ORs, 3.02 and 10.76), longer length of stay (ORs, 1.11 and 1.31), and higher cost (ORs, 1.09 and 1.22) than younger patients.

CONCLUSIONS

Elderly patients undergoing inpatient cholecystectomy have complex disease, with worse outcomes. Longer time from admission to surgery predicts poor outcome.

摘要

背景

胆石病随年龄增长而增加。本研究旨在衡量住院老年患者胆囊切除术的短期疗效，评估年龄的影响，并确定疗效的预测因素。

方法

本研究采用了回顾性队列研究方法，利用全国住院患者样本（1999-2006 年），纳入年龄在 65-79 岁和≥80 岁的老年患者（分别归入老年组 1 和老年组 2）和年龄在 50-64 岁的对照组，分析比较各组间住院接受胆囊切除术患者的短期疗效。采用线性和逻辑回归模型评估年龄与疗效的关系。主要观察指标包括院内死亡率、并发症、出院去向、平均住院时间和医疗费用。

结果

共纳入年龄在 65-79 岁的患者 149855 例、年龄≥80 岁的患者 62561 例和年龄在 50-64 岁的患者 145675 例。老年患者有多种胆道疾病，从入院到手术的时间间隔更长，且接受的开放性手术更多。与年轻患者相比，年龄在 65-79 岁的患者和年龄≥80 岁的患者死亡率（调整比值比[OR]分别为 2.36 和 5.91）、并发症（OR 分别为 1.57 和 2.39）、非常规出院（OR 分别为 3.02 和 10.76）、住院时间更长（OR 分别为 1.11 和 1.31）和医疗费用更高（OR 分别为 1.09 和 1.22）的风险更高。