Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
World J Surg. 2020 Aug;44(8):2592-2600. doi: 10.1007/s00268-020-05515-0.
Preoperative assessment of geriatric-specific determinants of health may enhance perioperative risk stratification among elderly patients. This study examines effects of geriatric-specific variables on postoperative outcomes in patients undergoing elective major abdominal operations.
Patients included in the ACS NSQIP pilot Geriatric Surgery Research File program who underwent elective pancreatic, liver, and colorectal operations between 2014 and 2016 were examined. Multivariable analyses were performed to evaluate associations between patient-specific geriatric variables and risk of death, morbidity, readmission, and discharge destination.
A total of 4165 patients were included. Patients ≥85 years were more likely to die, experience postoperative morbidity, and be discharged to a facility (all p ≤ 0.039) than younger patients. Preoperatively, patients ≥85 years were more likely to use a mobility aid, have a prior fall, have consent signed by a surrogate, and to live alone at home prior to operation (all p < 0.001). After adjustment for ACS NSQIP-estimated probabilities of morbidity or mortality, no geriatric-specific preoperative risk factors were significantly associated with increased risk of death or complications in any age group (all p > 0.055). Patients 75-84 and ≥85 years were more likely to be discharged to facility (OR 2.33 and 4.75, respectively, both p < 0.001) compared to patients 65-74 years. All geriatric-specific variables: use of mobility aid, living alone, consent signed by a surrogate, and fall history, were significantly associated with discharge to a facility (all p ≤ 0.001).
After adjusting for comorbid conditions, geriatric-specific variables are not associated with postoperative mortality and morbidity among elderly patients; however, geriatric-specific variables are significantly associated with discharge to a facility.
术前评估老年患者的特定健康决定因素可以提高老年患者围手术期风险分层。本研究检查了老年特定变量对接受择期大腹部手术的患者术后结果的影响。
纳入了接受 2014 年至 2016 年择期胰腺、肝脏和结直肠手术的 ACS NSQIP 试验老年外科研究文件计划中的患者。进行多变量分析，以评估患者特定的老年变量与死亡、发病率、再入院和出院去向风险之间的关系。
共纳入 4165 例患者。年龄≥85 岁的患者比年轻患者更有可能死亡、术后出现并发症并被送往医疗机构（均 p≤0.039）。术前，年龄≥85 岁的患者更有可能使用助行器、跌倒、由代理人签署同意书以及在手术前独自在家居住（均 p＜0.001）。在调整 ACS NSQIP 估计的发病率或死亡率概率后，任何年龄组的老年特定术前危险因素均与死亡或并发症风险增加无关（均 p＞0.055）。75-84 岁和≥85 岁的患者比 65-74 岁的患者更有可能被送往医疗机构（OR 分别为 2.33 和 4.75，均 p＜0.001）。所有老年特定变量：使用助行器、独自生活、由代理人签署同意书和跌倒史，均与送往医疗机构显著相关（均 p≤0.001）。
在调整合并症后，老年特定变量与老年患者的术后死亡率和发病率无关；然而，老年特定变量与送往医疗机构显著相关。
