Søreide Kjetil, Desserud Kari F
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Scand J Trauma Resusc Emerg Med. 2015 Feb 3;23:10. doi: 10.1186/s13049-015-0099-x.
Becoming old is considered a privilege and results from the socioeconomic progress and improvements in health care systems worldwide. However, morbidity and mortality increases with age, and even more so in acute onset disease. With the current prospects of longevity, a considerable number of elderly patients will continue to live with good function and excellent quality of life after emergency surgical care. However, mortality in emergency surgery may be reported at 15-30%, doubled if associated with complications, and notably higher in patients over 75 years. A number of risks associated with death are reported, and a number of scores proposed for prediction of risk. Frailty, a decline in the physiological reserves that may make the person vulnerable to even the most minor of stressful event, appears to be a valid indicator and predictor of risk and poor outcome, but how to best address and measure frailty in the emergency setting is not clear. Futility may sometimes be clearly defined, but most often becomes a borderline decision between ethics, clinical predictions and patient communication for which no solid evidence currently exists. The number and severity of other underlying condition(s), as well as the treatment alternatives and their consequences, is a complex picture to interpret. Add in the onset of the acute surgical disease as a further potential detrimental factor on function and quality of life - and you have a perfect storm to handle. In this brief review, some of the challenging aspects related to emergency surgery in the elderly will be discussed. More research, including registries and trials, are needed for improved knowledge to a growing health care challenge.
变老被视为一种特权，这得益于全球社会经济的进步和医疗保健系统的改善。然而，发病率和死亡率会随着年龄的增长而上升，在急性发病的疾病中更是如此。鉴于当前的长寿前景，相当一部分老年患者在接受急诊外科治疗后仍将继续保持良好的功能和卓越的生活质量。然而，急诊手术的死亡率可能为15% - 30%，若伴有并发症则会翻倍，在75岁以上的患者中死亡率尤其更高。有许多与死亡相关的风险被报道，也有许多用于预测风险的评分方法被提出。虚弱，即生理储备的下降，这可能使个体即使面对最轻微的应激事件也变得脆弱，似乎是一个有效的风险指标和不良预后的预测因素，但在急诊环境中如何最好地应对和衡量虚弱尚不清楚。有时，无效治疗可能会被明确界定，但大多数情况下，它会成为伦理、临床预测和医患沟通之间的一个模糊决策，目前尚无确凿证据。其他基础疾病的数量和严重程度，以及治疗选择及其后果，是一幅难以解读的复杂图景。再加上急性外科疾病的发作作为对功能和生活质量的另一个潜在有害因素——你就面临着一场需要应对的完美风暴。在这篇简短的综述中，将讨论一些与老年患者急诊手术相关的具有挑战性的方面。需要进行更多的研究，包括登记研究和试验，以增进对这一日益严峻的医疗保健挑战的认识。
