Queen Alexandra Hospital, Portsmouth NHS Trust.
Ann R Coll Surg Engl. 2021 Mar;103(3):180-185. doi: 10.1308/rcsann.2020.7028.
The UK has an ageing population with an increased prevalence of frailty in the over 70s. Emergency laparotomy for acute intra-abdominal pathology is increasingly offered to this population. This can challenge decision making and information given to patients should not only be based on mortality outcomes but on relative expected quality of life and change to frailty syndromes.
This was a single site National Emergency Laparotomy Audit (NELA)-based retrospective cohort audit for consecutive cases in the septuagenarian population assessing mortality, length of stay outcome and subjective postoperative functioning. Follow-up was conducted between one and two years postoperatively to determine this.
Some 153 patients were identified throughout the single site NELA database. Median age was 79 years with a ratio of 1.7 men to women. Median rate of all-cause mortality was 35.3% at the median follow-up of 19 months. Median time from admission to death was 120 days. Of those who had died by the time of follow-up, significant preoperative indicators included clinical frailty scale ( < 0.0001), preoperative P-POSSUM (mortality). At follow-up, 35% responded to a quality of life follow-up. This revealed a decline in mid-term physical functioning, lower energy, higher fatigue and reduction in social functioning. There was also an increase in pre- and postoperative clinical frailty scale score.
In the septuagenarian-plus population it is important to consider not only risk stratification with mortality scoring (P-POSSUM or NELA-adjusted risk), but to take into account frailty. Postoperative rehabilitation and careful recovery is paramount. Where possible, during the counselling and consent for emergency laparotomy, significant postoperative long-term deterioration in physical, emotional and social function should be considered.
英国人口老龄化，70 岁以上人群虚弱症的发病率增加。对于这部分人群，越来越多的人选择接受紧急剖腹术治疗急性腹腔内病变。这对决策制定提出了挑战，并且提供给患者的信息不应仅基于死亡率结果，还应考虑相对预期的生活质量和虚弱综合征的变化。
这是一项基于国家紧急剖腹术审计（NELA）的单站点回顾性队列审计，针对 70 多岁人群中的连续病例，评估死亡率、住院时间结果和术后主观功能。在术后 1 至 2 年内进行随访以确定这些结果。
在整个单站点 NELA 数据库中确定了 153 例患者。中位年龄为 79 岁，男女比例为 1.7:1。中位随访 19 个月时的全因死亡率为 35.3%。从入院到死亡的中位时间为 120 天。在随访时已经死亡的患者中，术前有显著指标包括临床虚弱量表（ < 0.0001）、术前 P-POSSUM（死亡率）。在随访时，35%的患者对生活质量进行了随访。这显示出中期身体功能下降、能量降低、疲劳增加和社会功能下降。术前和术后临床虚弱量表评分也有所增加。
在 70 岁以上人群中，不仅要考虑死亡率评分（P-POSSUM 或 NELA 调整风险）进行风险分层，还要考虑虚弱情况。术后康复和精心恢复至关重要。在进行紧急剖腹术的咨询和同意时，如果可能，应考虑到术后身体、情感和社会功能的长期严重恶化。
