Kothari Pankti, Congiusta Dominick V, Merchant Aziz M
Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA.
Updates Surg. 2019 Mar;71(1):89-96. doi: 10.1007/s13304-018-0531-7. Epub 2018 Apr 16.
Frailty in the elderly population is an important predictor of surgical outcomes. It has been quantified by several models, including the modified frailty index, which has demonstrated applicability in many surgical subspecialties. We aim to conduct the first decade-long retrospective analysis of frailty and complications between open and laparoscopic colectomy. We used the American College of Surgeons National Surgical Quality Improvement Program database to identify colectomies performed between 2005 and 2014. Our primary outcome was 30-day mortality. Secondary outcomes were grouped into five categories: wound, hematologic, pulmonary, renal, or cardiac/vascular complications. Chi-square and multivariate logistic regression were used to identify significant predictors of outcomes. Of the 244,639 colectomies identified in our data set, 117,064 cases were included after exclusion criteria were applied. 42,192 (36%) cases were laparoscopic. Mortality rates among open colectomies in mFI cohorts 0, 1, 2, 3, and ≥ 4 were 1.2, 3.4, 7.9, 14.3, and 20.3%, respectively, while rates in laparoscopic colectomies 0.2, 0.7, 2, 3.5, and 5.4%, respectively (p < 0.05). Logistic regression showed increase likelihood of mortality with open colectomies in all mFI cohorts (p < 0.05). The open approach also had statistically significant higher rates of secondary outcomes in nearly all frailty levels. Our study analyzed the relationship of frailty, approach to colectomy, and postoperative complications. Laparoscopic colectomies resulted in lower mortality rates as well as less wound, hematologic, pulmonary, renal, and cardiovascular complications.
老年人群的衰弱是手术预后的重要预测指标。它已通过多种模型进行量化，包括改良衰弱指数，该指数已在许多外科亚专业中显示出适用性。我们旨在对开放和腹腔镜结肠切除术之间的衰弱与并发症进行首次为期十年的回顾性分析。我们使用美国外科医师学会国家外科质量改进计划数据库来识别2005年至2014年间进行的结肠切除术。我们的主要结局是30天死亡率。次要结局分为五类：伤口、血液学、肺部、肾脏或心脏/血管并发症。使用卡方检验和多变量逻辑回归来确定结局的显著预测因素。在我们的数据集中识别出的244,639例结肠切除术中，应用排除标准后纳入了117,064例病例。42,192例（36%）为腹腔镜手术。改良衰弱指数（mFI）队列0、1、2、3和≥4的开放结肠切除术中的死亡率分别为1.2%、3.4%、7.9%、14.3%和20.3%，而腹腔镜结肠切除术中的死亡率分别为0.2%、0.7%、2%、3.5%和5.4%（p<0.05）。逻辑回归显示，在所有mFI队列中，开放结肠切除术的死亡可能性增加（p<0.05）。在几乎所有衰弱水平上，开放手术的次要结局发生率在统计学上也显著更高。我们的研究分析了衰弱、结肠切除手术方式与术后并发症之间的关系。腹腔镜结肠切除术导致较低的死亡率以及较少的伤口、血液学、肺部、肾脏和心血管并发症。
