Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Division of Gastrointestinal, Breast, and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Ann Surg. 2021 Sep 1;274(3):e253-e261. doi: 10.1097/SLA.0000000000003585.
To establish a preoperative risk assessment method for loss of independence after hepatic resection.
Hepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery.
In this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n = 232) and validation (n = 115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths).
In the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with 1 applicable risk factor, 25.5% and 25.0% among those with 2 applicable risk factors, and 56.3% and 50.0% among those with all 3 factors applicable (P < 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively.
Preoperative risk assessments using these 3 factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.
建立肝切除术后丧失独立性的术前风险评估方法。
肝切除术后常导致术前自理能力强的老年人丧失独立性。因此，老年患者应慎重选择手术。
在这项前瞻性、多中心研究中，将 347 名年龄≥65 岁、计划行肝切除术的独立生活患者分为研究（n = 232）和验证（n = 115）队列。我们研究了研究队列中术后丧失独立性的危险因素，并在验证队列中验证了我们的发现。丧失独立性定义为转至康复机构、出院至家庭医疗保健住所、因功能不佳 30 天内再次入院和 90 天内死亡（癌症相关死亡除外）。
在研究队列中，单因素和多因素分析表明，虚弱、年龄≥76 岁和开放性手术是术后丧失独立性的独立危险因素。研究和验证队列中无适用危险因素的患者术后丧失独立性的比例分别为 3.0%和 0%，有 1 个适用危险因素的患者分别为 8.1%和 12.5%，有 2 个适用危险因素的患者分别为 25.5%和 25.0%，有 3 个因素均适用的患者分别为 56.3%和 50.0%（两组均 P < 0.001）。研究组和验证组受试者工作特征曲线下面积分别为 0.777 和 0.783。
使用这 3 个因素进行术前风险评估可能有助于预测和规划老年患者肝切除术后丧失独立性。
