Hentati Hassen, Salloum Chady, Caillet Philippe, Lahat Eylon, Disabato Mara, Levesque Eric, Compagnon Philippe, Lim Chetana, Azoulay Daniel
Department of Digestive, Hepato-Bilio-Pancreatic Surgery Unit and Liver Transplantation, AP-HP Henri-Mondor Hospital, Université Paris, Est - UPEC, Est - 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
Department of Internal and Geriatric Medicine, AP-HP Henri-Mondor Hospital, Université Paris Est - UPEC, 94010, Creteil, France.
World J Surg. 2018 Jul;42(7):1988-1996. doi: 10.1007/s00268-017-4419-3.
Emergency digestive surgery is being increasingly performed in elderly patients. The aim of the present study was to identify the predictors of mortality and morbidity following emergency digestive surgery in patients aged 80 years and older.
A single-center retrospective review was performed of consecutive patients aged ≥65 years operated for a digestive surgical emergency between January 2011 and December 2013. Two groups were compared: group A (aged 65-79 years) and group B (aged ≥80 years).
The study population included 185 patients: 76 patients in group A and 109 in group B. The mean age was 79.9 years (65-104 years). The overall 90-day mortality rate was 23.2 and 31.9% at 1 year, which was similar between groups. The overall morbidity was 28.6%. No differences were noted between the two groups in overall, minor (Dindo I-II) or major (Dindo III-IV) morbidity rates. Multivariate analysis identified pulmonary disease (odds ratio, OR = 6.43, p = 0.02), bowel ischemia (OR = 11.41, p = 0.01), postoperative ICU stay (OR = 7.37, p < 0.0001) and the occurrence of postoperative complications (OR = 2.66, p = 0.03) as predictors of 90-day mortality. Predictors of in-hospital morbidity were preoperative hemoglobin <12 g/dL (OR = 2.49, p = 0.02) and postoperative intensive care unit (ICU) stay (OR = 6.69, p < 0.0001). An age ≥80 year was not associated with mortality or morbidity in this study.
The decision to perform abdominal surgery in the emergency setting should be based on physiological status, which accounts for a patient's comorbidities and health status, rather than on chronological age per se.
老年患者接受急诊消化外科手术的情况日益增多。本研究旨在确定80岁及以上患者急诊消化外科手术后死亡和发病的预测因素。
对2011年1月至2013年12月期间因消化外科急诊接受手术的年龄≥65岁的连续患者进行单中心回顾性研究。比较两组：A组（65 - 79岁）和B组（≥80岁）。
研究人群包括185例患者：A组76例，B组109例。平均年龄为79.9岁（65 - 104岁）。90天总死亡率为23.2%，1年时为31.9%，两组相似。总发病率为28.6%。两组在总体、轻微（Dindo I - II级）或严重（Dindo III - IV级）发病率方面均无差异。多因素分析确定肺部疾病（比值比，OR = 6.43，p = 0.02）、肠缺血（OR = 11.41，p = 0.01）、术后入住重症监护病房（ICU）（OR = 7.37，p < 0.0001）以及术后并发症的发生（OR = 2.66，p = 0.03）为90天死亡率的预测因素。院内发病的预测因素为术前血红蛋白<12 g/dL（OR = 2.49，p = 0.02）和术后入住重症监护病房（ICU）（OR = 6.69，p < 0.0001）。在本研究中，年龄≥80岁与死亡率或发病率无关。
在急诊情况下进行腹部手术的决策应基于生理状态，该状态考虑了患者的合并症和健康状况，而非单纯基于实际年龄。
