2002 年至 2014 年美国老年人择期和紧急大型腹部外科手术趋势。
U.S. trends in elective and emergent major abdominal surgical procedures from 2002 to 2014 in older adults.
机构信息
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, USA.
Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois, USA.
出版信息
J Am Geriatr Soc. 2021 Aug;69(8):2220-2230. doi: 10.1111/jgs.17189. Epub 2021 May 10.
BACKGROUND
The U.S. population is aging and projected to undergo an increasing number of general surgical procedures. However, recent trends in the frequency of major abdominal procedures in older adults are currently unknown as improvements in non-operative interventions may obviate the need for major surgery. Thus, we evaluated the trends of major abdominal surgical procedures in older adults in the United States.
METHODS
We performed a retrospective cohort study using the National Inpatient Sample from 2002 to 2014 with trend analysis using National Cancer Institute's Joinpoint Trend Analysis Software. We identified the average annual percent change (AAPC) in the yearly frequency of major abdominal surgical procedures in older adults (≥50 years of age).
RESULTS
Our cohort included a total of 3,951,947 survey-weighted discharges that included a major abdominal surgery in adults ≥50 years of age between 2002 and 2014. Of these discharges, 2,529,507 (64.0%) were for elective abdominal surgeries, 2,062,835 (52.0%) were for female patients, and mean (SD) age was 61.4 (15.9) years. The frequency of major abdominal procedures (elective and emergent) decreased for adults aged 65-74 (AAPC: -1.43, -1.75, -1.11, p < 0.0001), 75-84 (AAPC: -2.75, -3.33, -2.16, p < 0.001), and ≥85 (AAPC: -4.07, -4.67, -3.47, p < 0.0001). The AAPC for elective procedures decreased for older adults aged 75-84 (AAPC = -1.65; -2.44, -0.85: p = 0.0001) and >85 (AAPC = -3.53; -4.57, -2.48: p < 0.0001). All age groups showed decreases in emergent procedures in 50-64 (AAPC = -1.76, -2.00, -1.52, p < 0.0001), 65-74 (AAPC = -3.59, -4.03, -3.14, p < 0.0001), 75-84 (AAPC = -3.90, -4.34, -3.46, p < 0.0001), ≥85 (AAPC = -4.58, -4.98, -4.17, p < 0.0001) age groups.
CONCLUSIONS AND RELEVANCE
In this cohort of older adults, the frequency of emergent and elective major abdominal procedures in adults ≥65 years of age decreased with significant variation among individual procedure types. Future studies are needed to identify the generalizability of our findings to other surgical procedures.
背景
美国人口老龄化，预计将进行越来越多的普通外科手术。然而，目前尚不清楚老年人中主要腹部手术的频率趋势，因为非手术干预的改进可能会避免主要手术的需要。因此，我们评估了美国老年人主要腹部手术的趋势。
方法
我们使用 2002 年至 2014 年的国家住院患者样本进行了回顾性队列研究，并使用国家癌症研究所的 Joinpoint 趋势分析软件进行了趋势分析。我们确定了≥50 岁成年人中主要腹部手术频率的年度平均百分比变化（AAPC）。
结果
我们的队列包括总共 3951947 例经调查加权的出院患者，其中包括 2002 年至 2014 年间≥50 岁成年人的主要腹部手术。在这些出院患者中，2529507 例（64.0%）为择期腹部手术，2062835 例（52.0%）为女性患者，平均（SD）年龄为 61.4（15.9）岁。择期和紧急腹部手术的频率（择期和紧急）下降到 65-74 岁的成年人（AAPC：-1.43，-1.75，-1.11，p<0.0001），75-84 岁（AAPC：-2.75，-3.33，-2.16，p<0.001）和≥85 岁（AAPC：-4.07，-4.67，-3.47，p<0.0001）。75-84 岁（AAPC=-1.65；-2.44，-0.85：p=0.0001）和>85 岁（AAPC=-3.53；-4.57，-2.48：p<0.0001）的老年人择期手术的 AAPC 下降。所有年龄组的 50-64 岁（AAPC=-1.76，-2.00，-1.52，p<0.0001），65-74 岁（AAPC=-3.59，-4.03，-3.14，p<0.0001），75-84 岁（AAPC=-3.90，-4.34，-3.46，p<0.0001）和≥85 岁（AAPC=-4.58，-4.98，-4.17，p<0.0001）年龄组的紧急手术频率均下降。
结论和相关性
在这组老年人中，≥65 岁成年人的紧急和择期主要腹部手术的频率随着个别手术类型的显著变化而降低。未来的研究需要确定我们的发现对其他手术的普遍性。
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