Wallace Brendan, Breau Rodney H, Cnossen Sonya, Knee Christopher, Mcisaac Daniel, Mallick Ranjeeta, Cagiannos Ilias, Morash Christopher, Lavallée Luke T
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Can Urol Assoc J. 2018 Aug;12(8):256-259. doi: 10.5489/cuaj.5022. Epub 2018 Apr 6.
More elderly patients are presenting for surgical consultation. Understanding the risk of mortality by age group after urological surgery is important for patient selection and counselling.
A historical cohort study of The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006-2015 was performed. Current procedural terminology (CPT) codes for similar surgical procedures were grouped for analyses. Urological procedures commonly performed in elderly patients were identified and stratified by patient age and surgical approach (open vs. laparoscopic/robotic). The primary outcome was the absolute risk of death by 30 days stratified by age for each surgical procedure. The secondary outcome was risk of death by surgical approach (open vs. laparoscopic/robotic).
Twelve urological procedures were reviewed including 124 262 patients. A total of 1011 (0.8%) deaths occurred by 30 days after surgery. The procedure with the highest incidence of mortality by 30 days was open nephroureterectomy (2.9 %). In patients 80 years and over, the procedure with the highest incidence of death was open radical nephrectomy (5.32%). There was an increased risk of mortality with increasing age group for all procedures. Unadjusted risk of mortality was consistently higher in patients who receive open compared to laparoscopic surgery.
There is an increasing risk of mortality with age and with open surgical approach in urology. Knowledge regarding the absolute risk of mortality in patients receiving common urological surgeries may improve patient selection and counselling.
越来越多的老年患者前来进行外科会诊。了解泌尿外科手术后各年龄组的死亡风险对于患者选择和咨询至关重要。
对美国外科医师学会国家外科质量改进计划（NSQIP）2006 - 2015年的数据库进行历史性队列研究。对类似外科手术的当前程序编码（CPT）进行分组分析。确定老年患者常见的泌尿外科手术，并按患者年龄和手术方式（开放手术与腹腔镜/机器人手术）进行分层。主要结局是每种外科手术按年龄分层的30天绝对死亡风险。次要结局是手术方式（开放手术与腹腔镜/机器人手术）的死亡风险。
回顾了12种泌尿外科手术，包括124262例患者。术后30天共有1011例（0.8%）死亡。术后30天死亡率最高的手术是开放性肾输尿管切除术（2.9%）。在80岁及以上的患者中，死亡率最高的手术是开放性根治性肾切除术（5.32%）。所有手术的死亡风险均随年龄组增加而增加。与腹腔镜手术相比，接受开放手术的患者未经调整的死亡风险始终更高。
泌尿外科手术中，年龄增长和开放手术方式会增加死亡风险。了解接受常见泌尿外科手术患者的绝对死亡风险可能会改善患者选择和咨询。
