询问老年人跌倒情况与手术结果的关系。
Relationship between asking an older adult about falls and surgical outcomes.
机构信息
Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado2Denver Veterans Affairs Medical Center, Denver, Colorado.
出版信息
JAMA Surg. 2013 Dec;148(12):1132-8. doi: 10.1001/jamasurg.2013.2741.
IMPORTANCE
More than one-third of all US inpatient operations are performed on patients aged 65 years and older. Existing preoperative risk assessment strategies are not adequate to meet the needs of the aging population.
OBJECTIVES
To evaluate the relationship of a history of falls (a geriatric syndrome) to postoperative outcomes in older adults undergoing major elective operations.
DESIGN, SETTING, AND PARTICIPANTS: This prospective, cohort study was conducted at a referral medical center. Persons aged 65 years and older undergoing elective colorectal and cardiac operations were enrolled. The predictor variable was having fallen in the 6 months prior to the operation.
MAIN OUTCOMES AND MEASURES
Postoperative outcomes measured included 30-day complications, the need for discharge institutionalization, and 30-day readmission.
RESULTS
There were 235 subjects with a mean (SD) age of 74 (6) years. Preoperative falls occurred in 33%. One or more postoperative complications occurred more frequently in the group with prior falls compared with the nonfallers following both colorectal (59% vs 25%; P = .004) and cardiac (39% vs 15%; P = .002) operations. These findings were independent of advancing chronologic age. The need for discharge to an institutional care facility occurred more frequently in the group that had fallen in comparison with the nonfallers in both the colorectal (52% vs 6%; P < .001) and cardiac (62% vs 32%; P = .001) groups. Similarly, 30-day readmission was higher in the group with prior falls following both colorectal (P = .04) and cardiac (P = .02) operations.
CONCLUSIONS AND RELEVANCE
A history of 1 or more falls in the 6 months prior to an operation forecasts increased postoperative complications, the need for discharge institutionalization, and 30-day readmission across surgical specialties. Using a history of prior falls in preoperative risk assessment for an older adult represents a shift from current preoperative assessment strategies.
重要性
超过三分之一的美国住院手术是在 65 岁及以上的患者中进行的。现有的术前风险评估策略不足以满足老龄化人口的需求。
目的
评估老年人在接受主要择期手术前 6 个月内发生跌倒（老年综合征）的病史与术后结果的关系。
设计、地点和参与者：这是一项在转诊医疗中心进行的前瞻性队列研究。招募了 65 岁及以上接受择期结直肠和心脏手术的患者。预测变量是在手术前 6 个月内跌倒过。
主要结果和测量指标
术后结果包括 30 天并发症、需要出院到医疗机构以及 30 天再入院。
结果
共有 235 名受试者，平均（SD）年龄为 74（6）岁。术前跌倒发生率为 33%。与非跌倒组相比，有过跌倒史的患者在接受结直肠（59%对 25%；P = .004）和心脏（39%对 15%；P = .002）手术后发生一种或多种术后并发症的频率更高。这些发现与年龄的增长无关。与非跌倒组相比，跌倒组在结直肠（52%对 6%；P < .001）和心脏（62%对 32%；P = .001）手术后更需要出院到医疗机构。同样，在接受过手术的患者中，有过跌倒史的患者在结直肠（P = .04）和心脏（P = .02）手术后 30 天再入院的比例更高。
结论和相关性
在手术前 6 个月内有 1 次或多次跌倒史的患者，预测术后并发症、需要出院到医疗机构以及 30 天再入院的风险增加，涉及多个外科专业。在老年患者的术前风险评估中使用既往跌倒史代表了从当前术前评估策略的转变。
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