Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Faculty of Medicine, KU Leuven, Leuven, Belgium.
Colorectal Dis. 2017 Sep;19(9):O329-O338. doi: 10.1111/codi.13821.
This study aims to describe the nature, incidence, severity and outcomes of in-hospital postoperative complications (POCs) in older patients undergoing elective surgery for colorectal cancer.
Patients ≥ 70 years old were identified from a prospectively collected database (2009-2015) focusing on the implementation of geriatric screening and assessment in patients with cancer. Medical and surgical POCs were retrieved retrospectively from the medical records, and the severity of the POCs was graded by the Clavien-Dindo (CD) grading system. The following outcomes were analysed comparing patients with and without CD ≥ 2 and CD ≥ 3 POCs: length of stay (LOS), transfer to the intensive care unit, 30-day readmission rates, 30-day and 1-year mortality.
In the 190 patients included, medical POCs (40.5%) were more frequent than surgical POCs (17.9%), and 37.9% experienced CD ≥ 2 POCs. The most common medical POCs were infections (26.8%), transient confusion or altered mental function (12.1%), cardiac arrhythmia (4.7%), and ileus/gastroparesis/prolonged recovery of transit (4.7%). The most common surgical POCs were surgical site infections (12.1%), wound dehiscence/bleeding (4.7%), anastomotic leak (3.7%) and surgical site bleeding (3.7%). The reoperation rate was 7.9%. CD ≥ 2 POCs led to 11 intensive care unit admissions and increased median postoperative LOS by 114% (P < 0.0001 for both), but did not significantly alter 30-day readmission and 30-day and 1-year mortality rates. CD ≥ 3 POCs increased LOS by 162% (P < 0.0001) and showed an increased 1-year mortality (P = 0.07).
This study shows that in-hospital medical and surgical complications after surgery for colorectal cancer in patients ≥ 70 years old are frequent and that complications lead to less favourable outcomes.
本研究旨在描述行择期结直肠癌手术的老年患者术后院内并发症（POC）的性质、发生率、严重程度和结局。
从一个前瞻性收集的数据库（2009-2015 年）中确定了≥70 岁的患者，该数据库重点关注癌症患者的老年筛查和评估的实施。从病历中回顾性检索医疗和手术 POC，并使用 Clavien-Dindo（CD）分级系统对 POC 的严重程度进行分级。分析比较了 CD≥2 级和 CD≥3 级 POC 患者的以下结局：住院时间（LOS）、转入重症监护病房、30 天再入院率、30 天和 1 年死亡率。
在纳入的 190 例患者中，医疗 POC（40.5%）比手术 POC（17.9%）更常见，37.9%的患者发生了 CD≥2 级 POC。最常见的医疗 POC 是感染（26.8%）、短暂性意识混乱或精神功能改变（12.1%）、心律失常（4.7%）和肠梗阻/胃轻瘫/转运延迟（4.7%）。最常见的手术 POC 是手术部位感染（12.1%）、伤口裂开/出血（4.7%）、吻合口漏（3.7%）和手术部位出血（3.7%）。再手术率为 7.9%。CD≥2 级 POC 导致 11 例患者转入重症监护病房，术后 LOS 中位数增加了 114%（两者均 P<0.0001），但 30 天再入院率和 30 天及 1 年死亡率没有显著改变。CD≥3 级 POC 使 LOS 增加了 162%（P<0.0001），并增加了 1 年死亡率（P=0.07）。
本研究表明，≥70 岁行结直肠癌手术的老年患者术后院内发生的医疗和手术并发症较为常见，且并发症导致预后更差。
