Gardner B, Palasti S
Department of Surgery, UMDNJ, Newark.
Surg Gynecol Obstet. 1990 Oct;171(4):299-304.
The hospital costs and clinical results of 304 patients who were more than 80 years old and who underwent general surgical procedures were evaluated. The over-all mortality rate was 14 per cent; 19.9 per cent occurred in patients admitted under emergency conditions as compared with 8.9 per cent that occurred in patients undergoing elective procedures (p less than 0.001). Seventy-nine per cent of the patients were discharged and 7 per cent required care in a skilled nursing facility. Survival rates were as good or better than standard life table survival rates for 80 year old patients. Costs were higher in those who were admitted under emergent conditions or who died in the hospital. Deaths were a result of complications of the primary disease rather than associated disease in most groups. Neither costs nor length of stay could accurately predict survival of individual patients. We concluded that health resources should be directed at treating problems, such as cholelithiasis, hernia or carcinoma, early before complications develop.
对304例80岁以上接受普通外科手术的患者的医院费用和临床结果进行了评估。总体死亡率为14%；急诊入院患者的死亡率为19.9%，而择期手术患者的死亡率为8.9%（p<0.001）。79%的患者出院，7%的患者需要在专业护理机构接受护理。生存率与80岁患者的标准生命表生存率一样好或更好。急诊入院或在医院死亡的患者费用更高。在大多数组中，死亡是原发性疾病的并发症而非相关疾病导致的。费用和住院时间均不能准确预测个体患者的生存情况。我们得出结论，医疗资源应针对胆石症、疝气或癌症等问题，在并发症发生前尽早进行治疗。
