Aakre Elin K, Ulvik Atle, Hufthammer Karl O, Jammer Ib
Department of Anaesthesia and Surgical Services, Haukeland University Hospital, Bergen, Norway.
Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
Acta Anaesthesiol Scand. 2020 Aug;64(7):913-919. doi: 10.1111/aas.13594. Epub 2020 Apr 27.
Emergency laparotomy (EL) is a high-risk procedure. However, available evidence regarding outcome after emergency surgery in very old patients is limited. The aim of this observational study was to investigate outcome following EL in patients ≥80 years of age.
This single-center retrospective study was undertaken at Haukeland University Hospital, Norway. Demographic data, pre-operative risk assessment, surgical procedures, intrahospital logistics, complications, mortality, and discharge data were collected from the medical records. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, 1-year mortality, post-operative complications, and level of care at discharge.
One hundred and six patients aged 80-96 years underwent EL between 2015 and 2016. Of these, 58% had cardiopulmonary disease, and 16% lived in a nursing home before surgery. Resection of colon was performed in 26 cases, adhesiolysis was performed in 24, and resection of small intestine in 18. Within 30 days, 28 patients died (26%), 15 during the first post-operative week. For 82% of the patients, at least one complication occurred, and medical complications were far more frequent than surgical. Post-operatively, pulmonary morbidity was found in 51 patients (48%) and delirium in 42 (40%). The number of intrahospital deaths was 25 (24%). Among the 81survivors, 53 were discharged to a nursing home (65%). One-year mortality was 47% (50/106).
Mortality after EL in octo- and nonagenarians is very high. Medical complications are more common than surgical, and functional decline is frequent. Future studies should focus on the effect of a care bundle including geriatric intervention in these patients.
急诊剖腹手术（EL）是一项高风险手术。然而，关于高龄患者急诊手术后结局的现有证据有限。本观察性研究的目的是调查80岁及以上患者急诊剖腹手术后的结局。
本单中心回顾性研究在挪威豪克兰大学医院进行。从病历中收集人口统计学数据、术前风险评估、手术过程、院内后勤、并发症、死亡率和出院数据。主要结局是30天死亡率。次要结局是90天死亡率、1年死亡率、术后并发症和出院时的护理级别。
2015年至2016年期间，106例年龄在80 - 96岁的患者接受了急诊剖腹手术。其中，58%患有心肺疾病，16%在手术前住在养老院。26例行结肠切除术，24例行粘连松解术，18例行小肠切除术。30天内，28例患者死亡（26%），15例在术后第一周内死亡。82%的患者至少发生了一种并发症，医疗并发症远比手术并发症频繁。术后，51例患者（48%）出现肺部并发症，42例（40%）出现谵妄。院内死亡人数为25例（24%）。在81名幸存者中，53例（65%）出院后入住养老院。1年死亡率为47%（50/106）。
八旬和九旬老人急诊剖腹手术后的死亡率非常高。医疗并发症比手术并发症更常见，功能衰退频繁。未来的研究应关注包括老年干预在内的护理套餐对这些患者的影响。
