65 岁以上伴有急性复杂胆石病的患者需要接受不同的治疗 - ESTES 快照审核的结果和见解。
Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently-Results and Insights from the ESTES Snapshot Audit.
机构信息
Division of Traumatology, Emergency Surgery & Surgical Critical Care, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, 19104, USA.
School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
出版信息
World J Surg. 2021 Jul;45(7):2046-2055. doi: 10.1007/s00268-021-06052-0. Epub 2021 Apr 3.
BACKGROUND
Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms.
METHODS
The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management.
RESULTS
The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p < 0.001). Surgical complications were more frequent in the ≥ 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients ≥ 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or post-discharge rehabilitation need.
CONCLUSIONS
Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment.
TRIAL REGISTRATION
ClinicalTrials.gov (Trial # NCT03610308).
背景
已累积的合并症被认为会增加手术风险。外科医生可能较少为患有急性复杂胆石病（ACCBD）的老年患者提供手术治疗。我们旨在捕捉整个欧洲老年患者中 ACCBD 的发病率和当前使用的治疗方案。
方法
欧洲创伤和急诊外科学会（ESTES）对 2018 年 10 月 1 日至 31 日期间因 ACCBD 而紧急住院的患者进行了一次快照审核，比较了年龄在 65 岁以下和 65 岁及以上的患者。比较了两组患者的死亡率、术后并发症、手术干预时间、急性后处置和住院时间（LOS）。在年龄≥65 岁的患者中，还进一步比较了接受手术和非手术治疗的患者之间的合并症负担、死亡率、LOS 和处置结果。
结果
338 名入院患者的中位年龄为 67 岁；其中 185 名患者（54.7%）年龄为 65 岁或以上。接受手术治疗的患者年龄≥65 岁的比例明显较低（37.8%比 64.7%，p<0.001）。年龄≥65 岁的患者中，手术并发症更为常见，术后 LOS 明显延长。年龄≥65 岁的患者中术后死亡率为 2.2%（与 0.7%相比，p=0.253）。然而，接受手术的老年患者与未接受手术的患者在合并症负担、死亡率、LOS 或出院后康复需求方面没有差异。
结论
接受 ACCBD 手术治疗的老年患者很少。可以预料的是，老年患者的术后发病率、LOS 和出院后康复需求高于年轻患者，但与接受非手术治疗的老年患者没有差异。通过多学科围手术期优化，老年患者可能会安全地获得最佳治疗。
试验注册
ClinicalTrials.gov（试验编号：NCT03610308）。
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