Department of Anesthesiology, Icahn School of Medicine, Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine, Mount Sinai, New York, New York; Department of Geriatrics and Palliative Care, Icahn School of Medicine, Mount Sinai, New York, New York.
J Am Geriatr Soc. 2014 May;62(5):829-35. doi: 10.1111/jgs.12794. Epub 2014 Apr 14.
To determine whether procedures, hospitals visited, and complications would differ according to decade in elderly adults and from those of younger adults.
Retrospective cohort study.
The Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (NACOR) is the largest database of anesthesia cases from academic and community hospitals and includes all insurance and facility types across the United States.
Eight million six hundred thirty-two thousand nine hundred seventy-nine cases from January 2010 to March 2013 were acquired. After exclusion of individuals younger than 18, nonapplicable locations, and brain death, 2,851,114 remained and were placed into age categories (18-64, 65-69, 70-79, 80-89, ≥ 90).
Participant, surgical, anesthetic, and hospital descriptors and short-term outcomes (major complications, mortality at <48 hours).
The largest number of older adults had surgery in medium-sized community hospitals. The oldest age group (≥ 90) underwent the smallest range of procedures; hip fracture, hip replacement, and cataract procedures accounted for more than 35% of all surgeries. Younger old adults underwent these procedures plus a significant proportion of spinal fusion, cholecystectomy, and knee surgery. Older adults had greater mortality and more complications than younger adults. Participants undergoing exploratory laparotomy had the greatest likelihood of death in any age category except 90 and older, in which small bowel resection predominated. The proportion of emergency surgery and the mortality associated with emergency surgery was 30% higher in the oldest group (≥ 90) than in adults aged 18 to 64.
This article reports the pattern of surgical procedures, complications, and mortality found in NACOR, which is one of the few data sets that contains data from community hospitals and individuals with all types of insurance. Because the outcomes portion of the data set is under development, it is not possible to investigate the relationship between hospital type and complications or mortality, but this study underscores the magnitude of geriatric surgery that occurs in community hospitals as an area for future outcomes studies.
确定老年人和年轻人在手术程序、就诊医院和并发症方面是否存在差异。
回顾性队列研究。
麻醉质量协会国家麻醉临床结果登记处（NACOR）是来自学术和社区医院的最大麻醉病例数据库，涵盖美国所有的保险和医疗机构类型。
从 2010 年 1 月至 2013 年 3 月共获得 863.2979 例病例。排除 18 岁以下、不适用的地点和脑死亡患者后，共纳入 285.114 例患者，并分为年龄组（18-64 岁、65-69 岁、70-79 岁、80-89 岁、≥90 岁）。
患者、手术、麻醉和医院特征及短期结局（主要并发症、48 小时内死亡率）。
最大数量的老年患者在中等规模的社区医院接受手术。年龄最大组（≥90 岁）接受的手术种类最少；髋部骨折、髋关节置换和白内障手术占所有手术的 35%以上。较年轻的老年患者还接受了脊柱融合术、胆囊切除术和膝关节手术。与年轻患者相比，老年患者的死亡率和并发症发生率更高。除 90 岁及以上组（≥90 岁）以小肠切除术为主导的手术外，在任何年龄组中，接受剖腹探查术的患者死亡的可能性最大。在年龄最大组（≥90 岁）中，急诊手术的比例和与急诊手术相关的死亡率比 18-64 岁的成年人高 30%。
本文报告了 NACOR 中发现的手术程序、并发症和死亡率模式，该数据库是为数不多的包含社区医院和各类保险患者数据的数据集之一。由于该数据集的结局部分正在开发中，因此无法调查医院类型与并发症或死亡率之间的关系，但本研究突出了社区医院进行老年手术的规模，这是未来结局研究的一个领域。
