老年患者胰体尾切除术的手术结果。

Surgical Outcomes of Distal Pancreatectomy in Elderly Patients.

机构信息

Department of Surgery, 51374Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.

Western Michigan Cancer Center, Kalamazoo, MI, USA.

出版信息

Am Surg. 2022 Jan;88(1):115-119. doi: 10.1177/0003134820982574. Epub 2020 Dec 21.

DOI:10.1177/0003134820982574

PMID:33342301

Abstract

BACKGROUND

The extent to which age impacts surgical outcomes remains poorly characterized. This study aims to evaluate the impact of age on 30-day outcomes in patients after distal pancreatectomy.

METHODS

Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), distal pancreatectomy patients were identified and age-stratified, groups A (≤75 years) and B (>75 years). Outcomes included 30-day mortality, morbidity, readmissions, operative time (min), and hospital length of stay (LOS, days).

RESULTS

Of 3042 total patients identified, 1686 (55.4%) were women. A total of 2649 patients (87.1%) were in group A. Overall, both groups had similar baseline characteristics with the exception of the following: diabetes mellitus (24.8% vs. 30.0%, = .03), smoking (19.3% vs. 4.8%, < .001), congestive heart failure (.5% vs. 1.8%, = .010), hypertension (HTN) (47.9% vs. 72.5%, < .001), bleeding disorders (3.1% vs. 5.3%, = .036), the American Society of Anesthesiologists (ASA) (III-V) scores (67.6% vs. 85.5%, < .001), and body mass index (29.2 [±6.7] vs. 27.4 [±5.6], = .001).Deep surgical site infection was higher in group A (12.1% vs. 6.6%, = .001), while acute renal failure (ARF) and postoperative myocardial infarction (MI) were higher in group B. 30-day readmissions were higher in group A (17.4% vs. 12.2%, = .011) despite no statistically significant difference in LOS (7.10 [±6.36] vs. 7.30 [±4.93] days, = .553) or overall morbidity (29.4% vs. 28.8%, = .859).

CONCLUSION(S): Those undergoing distal pancreatectomy experienced similar overall morbidity and mortality outcomes regardless of age. However, those older than 75 years had more cardiovascular risk factors, which may have contributed to their higher rates of postoperative ARF and MI.

摘要

背景

年龄对手术结果的影响程度仍未得到充分描述。本研究旨在评估年龄对接受胰体尾切除术患者 30 天结局的影响。

方法

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（2017 年），确定并对接受胰体尾切除术的患者进行年龄分层，分为 A 组（≤75 岁）和 B 组（>75 岁）。结果包括 30 天死亡率、发病率、再入院率、手术时间（分钟）和住院时间（天）。

结果

在确定的 3042 例患者中，1686 例（55.4%）为女性。A 组共 2649 例（87.1%）。总体而言，两组的基线特征相似，除以下特征外：糖尿病（24.8%比 30.0%， =.03）、吸烟（19.3%比 4.8%， <.001）、充血性心力衰竭（0.5%比 1.8%， =.010）、高血压（47.9%比 72.5%， <.001）、出血性疾病（3.1%比 5.3%， =.036）、美国麻醉医师协会（ASA）分级（III-V 级）（67.6%比 85.5%， <.001）和体重指数（29.2[±6.7]比 27.4[±5.6]， =.001）。A 组深部手术部位感染发生率较高（12.1%比 6.6%， =.001），而 B 组急性肾衰竭（ARF）和术后心肌梗死（MI）发生率较高。尽管 A 组 30 天再入院率较高（17.4%比 12.2%， =.011），但住院时间（7.10[±6.36]比 7.30[±4.93]天， =.553）或总发病率（29.4%比 28.8%， =.859）无统计学差异。