Faculty of Health and Medical Sciences, The University of Adelaide Medical School, Adelaide, South Australia, Australia.
Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia.
World J Surg. 2021 Mar;45(3):841-848. doi: 10.1007/s00268-020-05850-2. Epub 2020 Nov 4.
With an ageing population, it is paramount for surgeons to comprehend the implications of age on surgical outcomes. This study aims to identify the effects of age on perioperative outcomes post-hepatectomy.
Between 2001 and 2017, 357 hepatectomies were performed in our centre for malignancy. Data recorded include demographic, histopathology and perioperative outcomes. Patients were divided into three age groups (Group 1 < 65 years, Group 2 65-74 years, Group 3 ≥ 75 years).
With increasing age, there was a trend towards patient having: ASA ≥ 3 (from 32.1% to 60.9%, p < 0.0001), clear margins (from 80.4% to 88.3%, p = 0.2256), days of hospitalisation (from 9.5 ± 6.9 to 12 ± 8.0, p = 0.0003), days of ICU admission (from 2.3 ± 2.8 to 2.8 ± 12.9, p = 0.0790) and morbidity (from 39% to 58.5%, p = 0.0073). Cardiovascular complications and postoperative delirium increase with age. There was no significant difference in mortality across the three groups. Univariate and bivariate binary logistic regressions found no association between mortality and age. When adjusted for age, 30- and 90-day mortality was significantly associated with Clavien-Dindo ≥ 3, length of hospital and cardiac complications. Additionally, 90-day mortality was significantly associated with ASA score ≥3, mass of liver resected, length of ICU stay and hepatobiliary, pulmonary and genitourinary complications.
Increased age is associated with increased post-hepatectomy complications, prolonged hospital stay and ICU admission. However, age itself is not a contraindication for hepatectomy and is not associated with increased mortality. Good histopathology outcomes and low mortality rates are achievable with careful patient selection and appropriate perioperative management.
随着人口老龄化，外科医生必须了解年龄对手术结果的影响。本研究旨在确定年龄对肝切除术后围手术期结果的影响。
在 2001 年至 2017 年间，我们中心对 357 例恶性肿瘤患者进行了肝切除术。记录的数据包括人口统计学、组织病理学和围手术期结果。患者分为三组（第 1 组年龄＜65 岁，第 2 组年龄 65-74 岁，第 3 组年龄≥75 岁）。
随着年龄的增长，患者的情况呈现出以下趋势：ASA≥3（从 32.1%增加到 60.9%，p＜0.0001）、切缘无肿瘤（从 80.4%增加到 88.3%，p=0.2256）、住院天数（从 9.5±6.9 天增加到 12±8.0 天，p=0.0003）、ICU 住院天数（从 2.3±2.8 天增加到 2.8±12.9 天，p=0.0790）和发病率（从 39%增加到 58.5%，p=0.0073）。心血管并发症和术后谵妄随年龄增长而增加。三组之间的死亡率无显著差异。单因素和双变量二项逻辑回归发现死亡率与年龄之间无关联。在校正年龄后，30 天和 90 天死亡率与 Clavien-Dindo≥3、住院时间和心脏并发症显著相关。此外，90 天死亡率与 ASA 评分≥3、切除肝的质量、ICU 住院时间以及肝胆、肺和泌尿生殖道并发症显著相关。
年龄增加与肝切除术后并发症增加、住院时间和 ICU 住院时间延长相关。然而，年龄本身并不是肝切除术的禁忌症，与死亡率增加无关。通过仔细的患者选择和适当的围手术期管理，可以实现良好的组织病理学结果和低死亡率。
