在两家三级转诊中心对老年人行开腹肝切除术。

Open hepatic resection in the elderly at two tertiary referral centers.

机构信息

Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.

Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.

出版信息

Am J Surg. 2021 Sep;222(3):594-598. doi: 10.1016/j.amjsurg.2021.01.024. Epub 2021 Jan 21.

DOI:10.1016/j.amjsurg.2021.01.024

PMID:33518291

Abstract

BACKGROUND

Surgeons are being increasingly called upon to operate on the very elderly. This study aimed to evaluate outcomes following hepatectomy in patients ≥80 years of age at two tertiary care centers.

METHODS

All adult patients who underwent liver resection from 2001 to 2017 were included. Primary outcome was 90-day postoperative mortality. Secondary outcomes included 30-day postoperative mortality and postoperative complications.

RESULTS

Between 2001 and 2017, 2397 patients underwent liver resection. On unadjusted analysis, patients ≥80 years of age had higher rates of 90-day mortality (13.3% vs. 3.6%, p < 0.001), 30-day mortality (5.6% vs. 1.8%, p = 0.01), MI (7.9% vs. 3.5%, p = 0.04), and UTI (10.0% vs. 4.5%, p = 0.02). On multivariable analysis, age ≥80 years was significantly associated with 90-day postoperative mortality (OR 4.51, 95%CI 2.11-9.67, p < 0.001).

CONCLUSIONS

Across these two major referral tertiary care centers, very elderly patients had higher rates of 90-day and 30-day postoperative mortality on both unadjusted and adjusted analyses.

摘要

背景

外科医生越来越多地被要求为非常高龄的患者进行手术。本研究旨在评估两家三级护理中心≥80 岁患者行肝切除术的结果。

方法

纳入 2001 年至 2017 年间行肝切除术的所有成年患者。主要结局为术后 90 天的死亡率。次要结局包括术后 30 天死亡率和术后并发症。

结果

2001 年至 2017 年间，共有 2397 例患者行肝切除术。在未调整分析中，≥80 岁的患者 90 天死亡率（13.3%比 3.6%，p<0.001）、30 天死亡率（5.6%比 1.8%，p=0.01）、心肌梗死（7.9%比 3.5%，p=0.04）和尿路感染（10.0%比 4.5%，p=0.02）的发生率更高。多变量分析显示，年龄≥80 岁与术后 90 天死亡率显著相关（OR 4.51，95%CI 2.11-9.67，p<0.001）。