Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig, Liebig Strasse 20, 04103, Leipzig, Germany.
BMC Geriatr. 2018 Jul 3;18(1):153. doi: 10.1186/s12877-018-0844-x.
The aim was to assess the morbidity and in-hospital mortality that occur in surgical patients with pre-existing dementia compared with those outcomes in non-dementia patients following emergent and nonemergent general surgical operations.
A total of 120 patients with dementia were matched for sex and type of surgery with 120 patients who did not have dementia, taken from a cohort of 15,295 patients undergoing surgery, in order to assess differences in surgical risk with dementia. Patient information was examined, including sex, body mass index (BMI), prevalence of individual comorbidities at admission, and several other variables that may be associated with postoperative outcomes as potential confounders.
Patients with dementia tended to have a higher overall complication burden compared to those without. This was evidenced by a higher average number of complications per patient (3.30 vs 2.36) and a higher average score on the comprehensive complication index (48.61 vs 37.60), values that were statistically significant for a difference between the two groups. The overall in-hospital mortality in patients with dementia was 28.3% (34 deaths out of 120 patients). During the same period, at our hospital, the overall in-hospital mortality in the control group was 20% (24 deaths out of 120 patients). Patient groups with and without dementia each had 3 and 5 associated risk factors for morbidity and 9 and 12 risk factors for mortality, respectively.
Patients with pre-existing dementia have a greater than average risk of early death after surgery, and their incidence of fatal complications is higher than that of surgical patients without dementia.
本研究旨在评估患有术前痴呆症的外科手术患者与非痴呆症患者在接受紧急和非紧急普通外科手术后的发病率和住院死亡率。
从 15295 例接受手术的患者队列中，为评估痴呆症患者的手术风险差异，我们按性别和手术类型对 120 例痴呆症患者与 120 例非痴呆症患者进行了配对。检查了患者的信息，包括性别、体重指数（BMI）、入院时的个体合并症患病率以及其他一些可能与术后结果相关的变量，这些变量可能是混杂因素。
与非痴呆症患者相比，痴呆症患者的整体并发症负担更高。这一点表现在每个患者的平均并发症数量（3.30 与 2.36）和综合并发症指数（48.61 与 37.60）的平均评分更高，两组间差异有统计学意义。痴呆症患者的住院总死亡率为 28.3%（120 例患者中有 34 例死亡）。同期，在我院，对照组的住院总死亡率为 20%（120 例患者中有 24 例死亡）。患有和未患有痴呆症的患者组分别有 3 个和 5 个与发病率相关的风险因素，以及 9 个和 12 个与死亡率相关的风险因素。
患有术前痴呆症的患者在手术后早期死亡的风险高于平均水平，其致命并发症的发生率高于无痴呆症的手术患者。
