Department of Surgery, Downstate Medical Center, State University of New York, Brooklyn, New York.
Department of Surgery, Downstate Medical Center, State University of New York, Brooklyn, New York; Department of Surgery, Coney Island Hospital, Brooklyn, New York.
J Surg Res. 2019 Jan;233:345-350. doi: 10.1016/j.jss.2018.07.064. Epub 2018 Sep 7.
With the population of octogenarians projected to increase fourfold by 2050, we sought to compare outcomes of laparoscopic versus open approach in octogenarians requiring surgery for adhesive small bowel obstruction (SBO).
METHODS/MATERIALS AND METHODS: Using 2006-2015 American College of Surgeons National Surgical Quality Improvement Project, we identified patients aged ≥80 y who underwent emergency surgery within 1 d of admission for SBO. Risk variables of interest included age, sex, race, body mass index, preoperative sepsis, and American Society of Anesthesiologists (ASA) classification. Outcomes included length of stay, mortality, and pneumonia. Univariable and multivariable analyses were performed.
Eight hundred fifty-six patients were identified. Six hundred ninety-nine (81.7%) underwent laparotomy; 157 (18.3%) underwent laparoscopy. Twenty-four (15.3%) of laparoscopic cases were converted. There was no difference between the open and laparoscopic groups in age, and race, preoperative albumin, or preoperative sepsis. The open group had higher rates of totally dependent functional status, congestive heart failure, chronic obstructive pulmonary disease, and higher ASA class. There was no difference in operative time. Laparoscopy was associated with shorter length of stay. The open approach showed higher rates of postoperative pneumonia, myocardial infarct, and mortality. Multivariable analysis showed increased age, functional status, preoperative albumin, and ASA class associated with mortality. The operative approach was not associated with mortality. Postoperative pneumonia was associated with male sex and open approach.
Age, preoperative functional status, low preoperative albumin, and ASA classes IV and V were associated with mortality, while the open approach and male sex were associated with postoperative pneumonia. Octogenarians who present with SBO due to adhesive disease may benefit from an initial laparoscopic exploration. Further prospective studies are warranted.
预计到 2050 年，80 岁以上人口将增加四倍，我们旨在比较腹腔镜与开腹手术治疗粘连性小肠梗阻（SBO）的 80 岁以上患者的结果。
方法/材料和方法：我们使用 2006-2015 年美国外科医师学会国家手术质量改进计划，确定了年龄≥80 岁的患者，他们在 SBO 入院后 1 天内接受紧急手术。感兴趣的风险变量包括年龄、性别、种族、体重指数、术前脓毒症和美国麻醉师协会（ASA）分级。结果包括住院时间、死亡率和肺炎。进行了单变量和多变量分析。
共确定了 856 名患者。699 名（81.7%）接受了剖腹手术；157 名（18.3%）接受了腹腔镜手术。24 例（15.3%）腹腔镜病例中转开腹。开放组和腹腔镜组在年龄、种族、术前白蛋白或术前脓毒症方面无差异。开放组完全依赖功能状态、充血性心力衰竭、慢性阻塞性肺疾病和更高的 ASA 分级的发生率较高。手术时间无差异。腹腔镜与较短的住院时间相关。开放组术后肺炎、心肌梗死和死亡率较高。多变量分析显示，年龄增加、功能状态、术前白蛋白和 ASA 分级与死亡率相关。手术方法与死亡率无关。术后肺炎与男性和开放手术有关。
年龄、术前功能状态、低术前白蛋白和 ASA 分级 IV 和 V 与死亡率相关，而开放手术和男性与术后肺炎相关。由于粘连性疾病而出现 SBO 的 80 岁以上患者可能受益于初始腹腔镜探查。需要进一步的前瞻性研究。
