Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, United Kingdom.
Dis Colon Rectum. 2012 Jul;55(7):788-96. doi: 10.1097/DCR.0b013e3182585a35.
Colorectal resection in elderly patients is associated with significant morbidity and mortality, especially in an emergency setting.
This study aims to quantify the risks associated with nonelective colorectal resection up to 1 year after surgery in elderly patients.
This is a population-based observational study.
Data were obtained from the Hospital Episode Statistics database.
All patients aged 70 years and older who underwent a nonelective colorectal resection in an English National Health Service Trust hospital between April 2001 and March 2008 were included.
: The primary outcomes measured were 30-day in hospital mortality, 365-day mortality, unplanned readmission within 28 days of discharge, and duration of hospital stay.
During the study period, 36,767 nonelective colorectal resections were performed in patients aged ≥ 70 years in England. Patients were classified into 3 age groups: A (70-75 years), B (76-80 years), and C (>80 years). Thirty-day mortality was 17.0%, 23.3%, and 31.0% in groups A, B, and C (p < 0.001). The overall 30-day medical complication rate was 33.7%, and the reoperation rate was 6.3%. Cardiac and respiratory complications were significantly higher in group C (22.2% and 18.2%, p < 0.001). Mortality in Group C was 51.2% at 1-year postsurgery. Advanced age was an independent determinant of mortality in risk-adjusted regression analyses.
This is a retrospective analysis of a prospective database. Stage of disease at presentation, severity of complications, and cause of death cannot be ascertained from this database.
In this population-based study, half of all English patients aged over 80 years undergoing nonelective colorectal resection died within 1 year of surgery. Further research is required to identify perioperative and postdischarge strategies that may improve survival in this vulnerable cohort.
老年患者的结直肠切除术与显著的发病率和死亡率相关，尤其是在紧急情况下。
本研究旨在量化 1 年内非择期结直肠切除术相关的风险，患者为老年患者。
这是一项基于人群的观察性研究。
数据来自医院发病统计数据库。
纳入 2001 年 4 月至 2008 年 3 月期间在英格兰国民保健服务信托医院接受非择期结直肠切除术且年龄 70 岁及以上的所有患者。
30 天住院死亡率、365 天死亡率、出院后 28 天内计划外再入院、以及住院时间。
研究期间，英格兰共有 36767 例 70 岁及以上患者接受了非择期结直肠切除术。患者分为 3 个年龄组：A 组（70-75 岁）、B 组（76-80 岁）和 C 组（>80 岁）。A、B 和 C 组的 30 天死亡率分别为 17.0%、23.3%和 31.0%（p < 0.001）。总体 30 天内医疗并发症发生率为 33.7%，再次手术率为 6.3%。C 组的心脏和呼吸并发症显著更高（22.2%和 18.2%，p < 0.001）。C 组患者术后 1 年死亡率为 51.2%。高龄是风险调整回归分析中死亡率的独立决定因素。
这是对前瞻性数据库的回顾性分析。本数据库无法确定患者就诊时的疾病分期、并发症严重程度和死亡原因。
在这项基于人群的研究中，一半以上的年龄在 80 岁以上接受非择期结直肠切除术的英国患者在术后 1 年内死亡。需要进一步研究以确定围手术期和出院后策略，这些策略可能会改善这一脆弱人群的生存率。
