Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
World J Surg. 2021 Jun;45(6):1868-1876. doi: 10.1007/s00268-021-05985-w. Epub 2021 Feb 17.
Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA).
Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications.
Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes.
Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.
老年人肝切除术后并不罕见术后并发症。然而，预测老年患者肝切除术后的风险并不容易。我们旨在开发一种新的术前评估方法，使用生物阻抗分析（BIA）预测 65 岁以上患者的术后并发症。
回顾性分析 2017 年至 2020 年在我院行肝切除术的 59 例连续患者（年龄 65 岁或以上）的临床资料。使用多变量回归分析评估术后并发症（Clavien-Dindo ≥ III）的危险因素。此外，还开发了一种新的术前风险评分来预测术后并发症。
15 例患者（25.4%）发生术后并发症，其中胆瘘是最常见的并发症。BIA 检测到的骨骼肌质量指数异常和手术类型被发现是多变量分析中的独立危险因素。这两个变量和术前血清白蛋白水平被用于开发风险评分。风险评分≤1 的术后并发症发生率为 0.0%，风险评分≥4 的术后并发症发生率为 57.1%。风险评分的受试者工作特征曲线下面积为 0.810（p=0.001），优于其他已知的手术风险指数。
骨骼肌减少和肝切除术的手术类型是老年患者择期肝切除术后发生术后并发症的独立危险因素。新的术前风险评分简单、易于操作，有助于检测行择期肝切除术的高危老年患者。
