Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan.
J Gastrointest Surg. 2019 Dec;23(12):2346-2353. doi: 10.1007/s11605-019-04117-z. Epub 2019 Feb 4.
The impact of cirrhosis on perioperative outcomes for elderly patients undergoing hepatectomy remains not well defined. We sought to determine the influence of underlying cirrhosis and minimally invasive surgery (MIS) on postoperative outcomes among elderly patients who underwent a hepatectomy.
Patients who underwent hepatectomy between 2013 and 2015 were identified using the Center for Medicare Services (CMS) 100% Limited Data Set (LDS) Standard Analytic Files (SAFs). Short-term outcomes after hepatectomy, stratified by the presence of cirrhosis and MIS, were examined.
Among 7452 patients who underwent a hepatectomy, a minority had cirrhosis (n = 481, 6.5%) whereas the vast majority did not (n = 6971, 93.5%). Overall, median patient age was 72 years (IQR 68-76) and preoperative Charlson comorbidity score was 6 (IQR 2-8). Patients with cirrhosis were more likely to be younger (median age 71 [67-76] vs 72 [IQR 68-76] years), male (64.4% vs 50%), African American (8.1% vs 6.4%) and have a malignant diagnosis (87.1% vs 78.7%) compared to non-cirrhotic patients (all p < 0.001). There was no difference among patients with and without cirrhosis regarding type of hepatectomy or surgical approach (open vs MIS) (both p > 0.05). Patients with versus without cirrhosis had similar complication rates (24.1% vs 22.3%, p = 0.36), as well as 30-day (6.2% vs 5%, p = 0.25) and 90-day (10.4% vs 8.5%, p = 0.15) mortality. MIS reduced the length-of-stay in non-cirrhotic patients (OR 0.79, 95% CI 0.62-0.99, p < 0.05), yet was not associated with morbidity or mortality (both p > 0.05).
The presence of cirrhosis did not generally impact outcomes in elderly patients undergoing hepatectomy for benign and malignant diseases. MIS hepatectomy in the elderly Medicare beneficiary population reduced LOS among patients without cirrhosis, yet was not associated with differences in morbidity or mortality.
肝硬化对老年患者行肝切除术围手术期结局的影响仍未明确。我们旨在确定基础肝硬化和微创外科（MIS）对接受肝切除术的老年患者术后结局的影响。
使用医疗保险服务中心（CMS）100%有限数据集（LDS）标准分析文件（SAFs），确定 2013 年至 2015 年期间接受肝切除术的患者。根据是否存在肝硬化和 MIS 分层，检查肝切除术后的短期结局。
在 7452 例接受肝切除术的患者中，少数患者（n=481，6.5%）存在肝硬化，而绝大多数患者（n=6971，93.5%）不存在肝硬化。总体而言，患者中位年龄为 72 岁（IQR 68-76 岁），术前 Charlson 合并症评分 6 分（IQR 2-8 分）。与非肝硬化患者相比，肝硬化患者更年轻（中位年龄 71 岁 [67-76] 岁 vs 72 岁 [IQR 68-76] 岁），男性（64.4% vs 50%），非裔美国人（8.1% vs 6.4%）和恶性诊断（87.1% vs 78.7%）更为常见（所有 p 值均<0.001）。在接受肝切除术的患者中，有或无肝硬化患者的手术方式（开腹 vs MIS）并无差异（均 p 值>0.05）。肝硬化患者和非肝硬化患者的并发症发生率相似（24.1% vs 22.3%，p 值=0.36），30 天死亡率（6.2% vs 5%，p 值=0.25）和 90 天死亡率（10.4% vs 8.5%，p 值=0.15）也相似。MIS 降低了非肝硬化患者的住院时间（OR 0.79，95%CI 0.62-0.99，p 值<0.05），但与发病率或死亡率无关（均 p 值>0.05）。
在接受良性和恶性疾病肝切除术的老年患者中，肝硬化的存在通常不会影响结局。MIS 肝切除术在老年医疗保险受益人群中降低了无肝硬化患者的住院时间，但与发病率或死亡率无差异。
