Phillip R. Lee Institute of Health Policy Studies, San Francisco, California 94118, USA.
J Am Geriatr Soc. 2012 May;60(5):967-73. doi: 10.1111/j.1532-5415.2012.03915.x. Epub 2012 Mar 16.
To determine functional status and mortality rates after colon cancer surgery in older nursing home residents.
Retrospective cohort study.
Nursing homes in the United States.
Six thousand eight hundred twenty-two nursing home residents aged 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005.
Changes in functional status were assessed before and after surgery using the Minimum Data Set Activity of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Regression techniques were used to identify patient characteristics associated with mortality and functional decline 1 year after surgery.
On average, residents who underwent colectomy had a 3.9-point worsening in MDS-ADL score at 1 year. One year after surgery, rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (≥ 80 vs 65-69, adjusted relative risk (ARR) = 1.53, 95% confidence interval (CI) = 1.15-2.04, P < .001), readmission after surgical hospitalization (ARR = 1.15, 95% CI = 1.03-1.29, P = .02), surgical complications (ARR = 1.11, 95% CI = 1.02-1.21, P = .01), and functional decline before surgery (ARR = 1.21, 95% CI = 1.11-1.32, P < .001) were associated with functional decline at 1 year.
Mortality and sustained functional decline are common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population.
确定老年疗养院居民结肠癌手术后的功能状态和死亡率。
回顾性队列研究。
美国疗养院。
1999 年至 2005 年期间在美国接受结肠癌手术的 6822 名 65 岁及以上的疗养院居民。
使用最低数据组日常生活活动（MDS-ADL）综合量表在手术前后评估功能状态的变化，该量表是一个 28 分的量表，分数增加表示功能依赖性增加。回归技术用于确定与手术后 1 年死亡率和功能下降相关的患者特征。
平均而言，接受结肠切除术的患者在 1 年内 MDS-ADL 评分恶化 3.9 分。手术后 1 年，死亡率和持续功能下降的发生率分别为 53%和 24%。在多变量分析中，年龄较大（≥80 岁与 65-69 岁，调整后的相对风险（ARR）=1.53，95%置信区间（CI）=1.15-2.04，P<.001）、手术后住院期间再次入院（ARR=1.15，95%CI=1.03-1.29，P=0.02）、手术并发症（ARR=1.11，95%CI=1.02-1.21，P=0.01）和手术前功能下降（ARR=1.21，95%CI=1.11-1.32，P<.001）与 1 年后的功能下降相关。
在疗养院居民中，结肠癌手术后死亡率和持续功能下降很常见。在这个弱势群体中，需要采取措施改善手术结果。
