Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Am J Surg. 2021 Sep;222(3):594-598. doi: 10.1016/j.amjsurg.2021.01.024. Epub 2021 Jan 21.
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.
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.
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).
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.
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。
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。
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）。
在这两家主要的三级转诊护理中心，无论在未调整还是调整分析中，非常高龄患者术后 90 天和 30 天的死亡率均较高。
