Kim Tanner I, Brahmandam Anand, Skrip Laura, Sarac Timur, Dardik Alan, Ochoa Chaar Cassius Iyad
From the *Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
†Yale School of Public Health, New Haven, Connecticut; and.
Am Surg. 2020 Jan 1;86(1):56-64.
Octogenarians and nonagenarians are considered the "very old" and are often viewed as one group. Americans are aging, with the proportion of the very old expected to increase from 1.9 per cent of the population to 4.3 per cent in 2050. This study aimed to underscore the differences in surgical trends, demographics, and outcomes between octogenarians and nonagenarians. The ACS-NSQIP database (2007-2012) was used to derive the type of surgeries, demographics, and outcomes of octogenarian and nonagenarians undergoing nonemergent vascular, orthopedic, and general surgery procedures. Between 2007 and 2012, nonagenarians accounted for an increasing percentage of surgeries (85 to 121 per 10,000 surgeries, relative risk = 1.42; 95% CI: 1.30-1.54) across surgical specialties, including vascular, general, and orthopedic surgery, whereas the percentage of octogenarians undergoing surgery remained unchanged. Nonagenarians had a higher 30-day perioperative mortality and a longer hospital stay than octogenarians after vascular, orthopedic, and general surgery procedures. Nonagenarians are a rapidly growing group of surgical patients with significantly higher perioperative mortality and longer postoperative hospital stay. The impact of surgery on the quality of life of nonagenarians needs to be studied to justify the increasing healthcare costs.
八旬老人和九旬老人被视为“非常年老的人”，通常被看作一个群体。美国人正在老龄化，预计到2050年，非常年老的人的比例将从占人口的1.9%增至4.3%。本研究旨在强调八旬老人和九旬老人在手术趋势、人口统计学特征及手术结果方面的差异。利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2007年至2012年），得出接受非急诊血管外科、骨科及普通外科手术的八旬老人和九旬老人的手术类型、人口统计学特征及手术结果。2007年至2012年期间，在包括血管外科、普通外科和骨科手术在内的各个外科专业中，九旬老人接受手术的比例不断增加（每10000例手术中从85例增至121例，相对危险度=1.42；95%可信区间：1.30 - 1.54），而八旬老人接受手术的比例保持不变。在接受血管外科、骨科和普通外科手术后，九旬老人的围手术期30天死亡率更高，住院时间更长。九旬老人是一个快速增长的外科患者群体，其围手术期死亡率显著更高，术后住院时间更长。需要研究手术对九旬老人生活质量的影响，以证明不断增加的医疗费用是合理的。
