Amato Bruno, Santoro Mario, Giugliano Giuseppe, Servillo Giuseppe, Di Nardo Veronica, Di Domenico Lorenza, Compagna Rita, Izzo Raffaele
University of Naples Federico II, Department of Clinical Medicine and Surgery.
Monaldi Arch Chest Dis. 2017 Jul 18;87(2):840. doi: 10.4081/monaldi.2017.840.
In the last 25 years, the number of patients aged ≥75 years undergoing non-cardiac surgery has greatly increased. In elderly patients, frailty is significantly associated with an increased risk of adverse events, functional decline, procedural complications, prolonged hospitalization, and mortality. The relationship between frailty and increased mortality and morbidity requires an appropriate tool of assessment to accurately quantify the patient's clinical and perioperative conditions. The preoperative evaluation of elderly patients candidate for non-cardiac surgery should include assessment of frailty, sarcopenia and malnutrition, as these are related to high surgical risk. For colon-rectal surgery as also for gastric cancer surgery, especially early gastric cancer, the introduction of laparoscopy has yielded considerable benefits in terms of short-term postsurgical outcomes, e.g. lower rate of intraprocedural bleeding and reduced length of hospital stay. Despite the progress made in preoperative assessment, surgical procedures and postoperative management, the improvement of outcomes after non-cardiac surgery in elderly patients remains a challenge and calls for future, well-designed clinical studies.
在过去25年中，接受非心脏手术的75岁及以上患者数量大幅增加。在老年患者中，虚弱与不良事件风险增加、功能衰退、手术并发症、住院时间延长和死亡率显著相关。虚弱与死亡率和发病率增加之间的关系需要一种合适的评估工具来准确量化患者的临床和围手术期状况。拟接受非心脏手术的老年患者的术前评估应包括对虚弱、肌肉减少症和营养不良的评估，因为这些与高手术风险相关。对于结直肠手术以及胃癌手术，尤其是早期胃癌，腹腔镜手术的引入在术后短期结局方面带来了相当大的益处，例如术中出血率降低和住院时间缩短。尽管在术前评估、手术操作和术后管理方面取得了进展，但老年患者非心脏手术后结局的改善仍然是一项挑战，需要未来设计良好的临床研究。
