Goeteyn Jens, Evans Louis A, De Cleyn Siem, Fauconnier Sigrid, Damen Caroline, Hewitt Jonathan, Ceelen Wim
a Department of GI Surgery , University Hospital , Ghent , Belgium.
b Department of Surgery , University Hospital Wales , Cardiff , UK.
Acta Chir Belg. 2017 Dec;117(6):370-375. doi: 10.1080/00015458.2017.1337339. Epub 2017 Jun 10.
The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days.
We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk.
Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p= .025) (hazard ratio (HR) 10.83 (95%CI 1.34-87.4)). Operation (p= .084) (HR 0.16 (95%CI 0.16-1.29)) and the presence of chronic cardiac failure (p= .049) (HR 0.38 (95%CI 0.14-0.99)) were protective for mortality at 90 days.
Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery.
Level II therapeutic study.
在过去几十年中，老年及体弱患者接受的外科手术数量大幅增加。然而，针对老年急诊普通外科患者的研究较少。本研究的目的是评估比利时急诊普通外科患者中虚弱的患病率。其次，我们考察了住院时间、再入院率以及30天和90天的死亡率。
我们在根特大学医院进行了一项前瞻性观察研究。所有从急诊科收治到普通外科病房的65岁以上患者均符合纳入标准。主要终点是30天死亡率。次要结局是90天死亡率、再入院情况和住院时间。采用Fisher精确检验、Mann-Whitney U检验或单因素方差分析进行横断面观察。我们进行了COX多变量分析，以确定与30天和90天死亡率以及再入院风险相关的独立变量。
在四个月的时间里收集了98例患者的数据。23.5%的患者被认为虚弱。所有患者中有79%接受了腹部手术。单因素分析显示，用药过多、多种疾病并存、跌倒史、听力障碍和尿失禁在非虚弱组和虚弱组之间在统计学上有显著差异。虚弱患者在30天内的死亡率较高（9%对1.3%（p = 0.053））。两组在90天死亡率、再入院率、住院时间和手术方面没有差异。虚弱是90天死亡率的一个预测因素（p = 0.025）（风险比（HR）10.83（95%可信区间1.34 - 87.4））。手术（p = 0.084）（HR 0.16（95%可信区间0.16 - 1.29））和慢性心力衰竭的存在（p = 0.049）（HR 0.38（95%可信区间0.14 - 0.99））对90天死亡率有保护作用。
虚弱是老年急诊腹部/普通外科手术患者死亡率的一个重要预测因素。
二级治疗研究。
