Khan-Kheil A M, Khan H N
University Hospital Coventry & Warwickshire NHS Trust , UK.
Ann R Coll Surg Engl. 2016 Mar;98(3):177-80. doi: 10.1308/rcsann.2015.0043. Epub 2015 Dec 16.
Patients aged >80 years account for a considerable proportion of the population admitted to hospital under general surgeons. We aimed to establish the prevalence of mortality in patients aged >80 years who underwent emergency general, vascular and urological surgery within a 13-month period at a large teaching hospital in the UK.
A retrospective analysis was carried out of all patients aged ≥80 years admitted on acute on-call emergency under general, vascular or urological surgeons. Patient demographics (including comorbidities and sex) were recorded. American Society of Anesthesiologists scores were reviewed from anaesthetic records. The outcome measure was 30-day mortality for those who had undergone emergency general, vascular or urological surgery.
A total of 4,069 patients were admitted under general, vascular and urological surgeons during the study period. Of these patients, 521 were aged >80 years. Sixty-three patients underwent emergency surgery and 12 died <30 days after surgery (mortality = 19%). The most common procedure was laparotomy (20 cases). The most common co-morbidity was cardiac disease, which included hypertension, ischaemic heart disease, and hypercholesterolemia. A considerable proportion of patients also had malignant disease and arthritis.
The present study suggests that emergency surgery should not be denied to subjects aged >80 years based on age alone. Mortality varies according to the type of emergency procedure. Mortality was highest after laparotomy and vascular surgery whereas, for more routine procedures such as hernia repair and abscess drainage, survival was almost 100% after 30 days.
80岁以上的患者在普通外科医生收治的住院患者中占相当大的比例。我们旨在确定在英国一家大型教学医院，年龄大于80岁的患者在13个月内接受急诊普通外科、血管外科和泌尿外科手术的死亡率。
对所有年龄≥80岁、由普通外科、血管外科或泌尿外科医生急性出诊收治的患者进行回顾性分析。记录患者的人口统计学信息（包括合并症和性别）。从麻醉记录中查看美国麻醉医师协会评分。观察指标是接受急诊普通外科、血管外科或泌尿外科手术患者的30天死亡率。
在研究期间，共有4069名患者由普通外科、血管外科和泌尿外科医生收治。其中，521名患者年龄大于80岁。63名患者接受了急诊手术，12名在术后30天内死亡（死亡率=19%）。最常见的手术是剖腹术（20例）。最常见的合并症是心脏病，包括高血压、缺血性心脏病和高胆固醇血症。相当一部分患者还患有恶性疾病和关节炎。
本研究表明，不应仅凭年龄就拒绝80岁以上的患者进行急诊手术。死亡率因急诊手术类型而异。剖腹术和血管手术后死亡率最高，而对于更常规的手术，如疝气修补术和脓肿引流术，30天后的生存率几乎为100%。
