Du Yang, Karvellas Constantine J, Baracos Vickie, Williams David C, Khadaroo Rachel G
Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada.
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada; Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Surgery. 2014 Sep;156(3):521-7. doi: 10.1016/j.surg.2014.04.027. Epub 2014 Jun 12.
With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery.
A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis.
The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm(2)/m(2)) was associated with decreased in-hospital mortality (odds ratio ∼0.834, 95% confidence interval 0.731-0.952, P = .007) in multivariate analysis.
Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future.
随着人口老龄化加剧，接受急诊手术的高龄患者（年龄≥80岁）数量不断增加。评估急性护理手术环境中患者特定的术后发病和死亡风险因素对于改善治疗结果至关重要。我们假设肌肉减少症，即骨骼肌的严重消耗，是高龄急诊手术患者发病和死亡的预测指标。
2008年至2010年期间，共有170名80岁以上的患者在一家三级医疗机构接受了急诊手术；其中100名患者在术后30天内有腹部计算机断层扫描图像，足以评估肌肉减少症。使用单变量和多变量分析评估肌肉减少症对手术结果的影响。
患者的平均年龄为84岁，住院死亡率为18%。73%的患者存在肌肉减少症。更多肌肉减少症患者出现术后并发症（肌肉减少症患者为45%，非肌肉减少症患者为15%，P = 0.005），且更多患者在医院死亡（分别为23%和4%，P = 0.037）。术后住院时间或重症监护病房需求无差异。在我们控制了混杂因素后，多变量分析显示骨骼肌指数增加（每增加1 cm²/m²）与住院死亡率降低相关（比值比约为0.834，95%置信区间为0.731 - 0.952，P = 0.007）。
在高龄急诊手术人群中，肌肉减少症是更高并发症发生率、出院情况和住院死亡率的独立预测指标。将肌肉减少症作为识别高危患者的客观工具，将有助于制定针对性的预防策略，并可能在未来进行资源分配。
