Division of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, The Netherlands,
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan,
Dig Surg. 2019;36(4):323-330. doi: 10.1159/000489826. Epub 2018 Jun 26.
BACKGROUND/AIMS: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients.
We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis.
Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52).
Although elderly -patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.
背景/目的：肝胰胆（HPB）手术后的死亡率和发病率仍然很高，需要接受此类手术的老年患者人数也在增加。本研究旨在探讨老年患者接受复杂 HPB 手术后的术后结果。
我们回顾性分析了 2010 年至 2015 年间接受复杂 HPB 手术的 721 例患者的围手术期数据。将患者分为两组：老年组（≥75 岁）和非老年组（<75 岁）。对两组患者进行倾向评分匹配分析后，比较手术结果。随后，通过多变量分析确定严重术后并发症的危险因素。
在匹配前，老年组（n = 170）比非老年组（n = 551）有更多的合并症，如心血管疾病和肾脏疾病。匹配后，老年组（n = 170）和非老年组（n = 170）的术前背景相似。两组患者的死亡率和发病率无显著差异。多变量分析显示，手术时间（OR 1.79；p = 0.005）和出血量（OR 1.66；p = 0.03）是严重术后并发症的独立危险因素，而年龄较大则没有预测作用（OR 1.16；p = 0.52）。
尽管老年患者在匹配前合并症更多，术后死亡率和几种并发症的发生率更高，但在匹配后，他们的术后结果与非老年患者相当。
