Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada; ¶interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Ann Surg. 2022 Dec 1;276(6):e851-e860. doi: 10.1097/SLA.0000000000004867. Epub 2021 Mar 22.
To evaluate healthcare dependency following hepatopancreato-biliary cancer surgery in older adults (OA).
Functional outcomes are central to decisionmaking by OA, but long-term risks of dependency have not been described beyond 1 year in this population.
All patients over age 70 undergoing hepatectomy or pancreatec-tomy for cancer between 2007 and 2017 in Ontario were analyzed. Outcomes were 1) receipt of homecare and 2) time at home. Homecare was analyzed with cumulative incidence functions, and time at home with Kaplan-Meier and Cox multivariate models.
A total of 902 and 1283 patients underwent hepatectomy and pancreatectomy, respectively. Homecare use was highest (72.3%) in postoperative month-1, decreasing to stabilize between year-1 (25.5%) and year-5 (18.3%). Repeated receipt of homecare was associated with female sex (HR 1.18, 95% CI 1.05-1.32), receipt of adjuvant therapy (HR 1.56, 1.37-1.78), and more recent year of surgery (HR 3.80, 3.05-4.72). The ratio of home nursing care versus personal support services reversed from 68%/26% in year-1, to 29/64% in year-5. High time at home (>350 days) at 1 and 5 years were 40.6% (95% CI 38.5%-42.6%) and 28.1% (25.9%-30.3%), respectively. The ratio of institution-days in acute care versus nursing homes went from 77%/14% in year-1 to 23%/70% in year-5. Low time at home was associated with duodenal (HR 1.45, 1.15-1.70) and pancreas cancer (HR 1.20, 1.02-1.42), and with rural residence (HR 1.24, 1.04-1.48). High time at home was associated with more recent year of surgery (HR 0.84, 0.76-0.93) and perioperative cancer therapy (HR 0.88, 0.78-0.99). Increasing age was neither associated with homecare receipt nor time at home.
Following hepatopancreatobiliary cancer surgery, there is a high rate of long-term healthcare dependency for OA. There is an immediate high need for homecare that reaches a new baseline after 6 months, and the majority of OA will have at least 1 year with low time at home, most commonly the first year. These findings can aid in preoperative preparation and transitional care planning.
评估老年（OA）人群行肝胆胰癌症手术后的医疗依赖情况。
对于 OA 患者来说，功能结果是决策的核心，但在该人群中，尚未描述 1 年以上的依赖长期风险。
分析了 2007 年至 2017 年间安大略省所有 70 岁以上行肝切除术或胰切除术的癌症患者。主要结局为 1）接受家庭护理，2）在家时间。采用累积发生率函数分析家庭护理的使用情况，采用 Kaplan-Meier 和 Cox 多变量模型分析在家时间。
共 902 例患者行肝切除术，1283 例患者行胰切除术。术后第 1 个月家庭护理使用率最高（72.3%），至第 1 年（25.5%）和第 5 年（18.3%）趋于稳定。反复接受家庭护理与女性（HR 1.18，95%CI 1.05-1.32）、辅助治疗（HR 1.56，1.37-1.78）和较晚年份手术（HR 3.80，3.05-4.72）相关。第 1 年家庭护理中护理人员与个人支持服务的比例为 68%/26%，第 5 年为 29%/64%。第 1 年和第 5 年在家时间（>350 天）分别为 40.6%（95%CI 38.5%-42.6%）和 28.1%（25.9%-30.3%）。第 1 年急性护理机构与疗养院天数比例为 77%/14%，第 5 年为 23%/70%。低在家时间与十二指肠（HR 1.45，1.15-1.70）和胰腺（HR 1.20，1.02-1.42）癌症以及农村居住地（HR 1.24，1.04-1.48）相关。高在家时间与较晚年份手术（HR 0.84，0.76-0.93）和围手术期癌症治疗（HR 0.88，0.78-0.99）相关。年龄增加与家庭护理的接受或在家时间无关。
肝胆胰癌症手术后，老年人群存在长期医疗依赖的高发生率。术后立即存在对家庭护理的高需求，6 个月后达到新的基线，大多数 OA 将至少有 1 年的低在家时间，通常是第 1 年。这些发现有助于术前准备和过渡性护理计划。
