Adams Peter D, Ritz Jennifer, Kather Ryan, Patton Pat, Jordan Jack, Mooney Roberta, Horst Harriette Mathilda, Rubinfeld Ilan
Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Am J Surg. 2014 Oct;208(4):656-62. doi: 10.1016/j.amjsurg.2014.03.006. Epub 2014 May 4.
Elderly patients are thought to tolerate surgical complications poorly because of low physiologic reserve. The purpose of the study was to evaluate the differential effects of surgical harm in patients over 80 years old.
Three years of data from a harm-reduction campaign were used to identify inpatient surgeries performed on patients older than 50. The rates of harm, death, cost, and length of stay (LOS) were analyzed using SPSS 21 (IBM, New York, NY).
A total of 22,710 patients were identified. Rates of harm and mortality increased with increasing age. Harmed patients over age 80 had increased mortality (9.5% vs 7%), but lower cost, intensive care unit days, and LOS versus those aged 50 to 80. Linear regression showed increased cost with harm ($24,000) and decreased cost with age above 80 (-$7,000).
In the elderly surgical population, there is more harm and harm events are associated with higher mortality rates, but less additional cost and LOS. Differing goals or aggressiveness of care may explain cost avoidance in the elderly.
由于生理储备较低，老年患者被认为对手术并发症的耐受性较差。本研究的目的是评估手术伤害对80岁以上患者的不同影响。
利用一项减少伤害运动的三年数据，确定对50岁以上患者进行的住院手术。使用SPSS 21（IBM，纽约州纽约市）分析伤害、死亡、成本和住院时间（LOS）发生率。
共识别出22,710名患者。伤害和死亡率随年龄增长而增加。80岁以上受伤害患者的死亡率增加（9.5%对7%），但与50至80岁患者相比，成本、重症监护病房天数和住院时间较低。线性回归显示，伤害会增加成本（24,000美元），80岁以上会降低成本（-7,000美元）。
在老年手术人群中，伤害更多，伤害事件与更高的死亡率相关，但额外成本和住院时间较少。不同的护理目标或积极性可能解释了老年人成本的避免。
