Department of General Surgery, Nevill Hall Hospital, Brecon Road, Abergavenny NP7 7EG, UK.
Postgrad Med J. 2012 Apr;88(1038):205-9. doi: 10.1136/postgradmedj-2011-130412. Epub 2012 Feb 25.
Patients presenting with peritonitis require rapid treatment initiation including laparotomy. In the older population, this often leads to Hartmann's procedure being performed. The decision to perform surgery may be a difficult, multidisciplinary decision balancing premorbid comorbidity and quality of life with knowledge of the postoperative outcome. However, the evidence for survival outcome of emergency surgery based on age is lacking. The aim of this study was therefore to assess the survival implication of age and other prognostic factors on the outcome after Hartmann's procedure.
A retrospective review of prospectively collected data of all patients undergoing emergency (National Confidential Enquiry into Patient Outcome and Death category 1-3) Hartmann's procedure in one NHS Health Board over a 5-year period.
129 patients underwent Hartmann's procedure between November 2004 and November 2009. The largest group, 61 patients (47.3%) had the procedure performed for perforated sigmoid diverticular disease. When examined at 5-year stratifications around the median, the most significant survival difference was seen at the age of 75 years (log rank χ(2) 11.246, p=0.001). Patients over 75 years had median survival significantly lower than those aged <75 years (p<0.001). However, Cox regression analysis showed that preoperative American Society of Anesthesiologists (ASA) status and haemoglobin were more significant independent predictors of mortality than this age strata (p=0.001 and 0.045 vs 0.660, respectively), adjusting for diagnosis.
ASA grade and common blood abnormalities were more predictive of mortality after Hartmann's procedure than the most significant age stratification. Furthermore, age was not independently associated with survival. It would therefore be unreasonable to refuse Hartmann's procedure based on an age alone.
患有腹膜炎的患者需要迅速开始治疗，包括剖腹手术。在老年人群中，这通常导致实施 Hartmann 手术。是否进行手术的决定是一个困难的、多学科的决策，需要平衡术前合并症和生活质量，以及对术后结果的了解。然而，基于年龄的紧急手术生存结果的证据是缺乏的。因此，本研究的目的是评估年龄和其他预后因素对 Hartmann 手术后结局的生存影响。
对一家英国国民保健署卫生委员会在 5 年内所有接受紧急（国家患者结果和死亡机密调查类别 1-3）Hartmann 手术的患者前瞻性收集的数据进行回顾性分析。
2004 年 11 月至 2009 年 11 月期间，共有 129 名患者接受了 Hartmann 手术。最大的一组（61 例，47.3%）因穿孔性乙状结肠憩室疾病而行该手术。在围绕中位数的 5 年分层检查中，最显著的生存差异发生在 75 岁年龄组（对数秩 χ(2) 11.246，p=0.001）。75 岁以上患者的中位生存期明显低于<75 岁患者（p<0.001）。然而，Cox 回归分析显示，术前美国麻醉医师协会（ASA）状态和血红蛋白是比这一年龄层更显著的独立死亡预测因素（p=0.001 和 0.045 与 0.660，分别），调整诊断后。
ASA 分级和常见血液异常对 Hartmann 手术后的死亡率预测比最显著的年龄分层更为准确。此外，年龄与生存无关。因此，仅仅基于年龄拒绝 Hartmann 手术是不合理的。
