急诊剖腹手术中的决策：预计预期寿命的作用。

Decision making in emergency laparotomy: the role of predicted life expectancy.

机构信息

Department of Undergraduate Medicine, School of Medicine, University of Glasgow, University Avenue, Glasgow, UK.

Department of Surgery, Royal Alexandra Hospital, Paisley, UK.

出版信息

BJS Open. 2021 Sep 6;5(5). doi: 10.1093/bjsopen/zrab090.

DOI:10.1093/bjsopen/zrab090

PMID:34633437

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8504444/

Abstract

INTRODUCTION

Increasing numbers of older patients are undergoing emergency laparotomy (EL). They are at increased risk of adverse outcomes, making the shared decision on whether to operate challenging. This retrospective cohort study aimed to assess the role of age and life-expectancy predictions on short- and long-term survival in patients undergoing EL.

METHODS

All patients who underwent EL at one hospital in the West of Scotland between March 2014 to December 2016 were included. Clinical parameters were collected, and patients were followed up to allow reporting of 30-, 60- and 90-day and 1-year mortality rates. Period life expectancy was used to stratify patients into below life expectancy (bLEP) and at-or-above life expectancy (aLEP) groups at presentation. Remaining life expectancy was used to calculate the net years of life gained (NYLG).

RESULTS

Some 462 patients underwent EL: 20 per cent in the aLEP group. These patients were older (P < 0.001), had more co-morbidities (P < 0.001) and were high risk on P-POSSUM scoring (P = 0.008). The 30-, 60- and 90-day and 1-year mortality rates were 11, 14, 16 and 23 per cent respectively. Advanced age (P = 0.011) and high ASA score (P = 0.004) and P-POSSUM score (P < 0.001) were independent predictors of death at 1 year on multivariable analysis. The cohort NYLG were 19.2 years. Comparing patients aged less than 70 with those aged 70 years or older, the NYLG were 25.9 versus 5.5 years. Comparing bLEP and aLEP, the NYLG were 22.2 versus 4.4 years. In patients aged 70 years and older, NYLG decreased by more than half in patients with co-morbidities (ASA score 3,4,5) (9.3 versus 4.3 years).

CONCLUSION

Discussions around long-term outcomes after emergency surgery remain difficult. Although age is an influencing factor, predicted life expectancy alone does not provide additional value to shared decision making.

摘要

介绍

越来越多的老年患者接受紧急剖腹手术（EL）。他们发生不良结局的风险增加，这使得是否进行手术的共同决策具有挑战性。本回顾性队列研究旨在评估年龄和预期寿命预测对接受 EL 的患者短期和长期生存的作用。

方法

纳入 2014 年 3 月至 2016 年 12 月在苏格兰西部一家医院接受 EL 的所有患者。收集临床参数，并对患者进行随访，以报告 30 天、60 天和 90 天及 1 年死亡率。使用期寿命来分层患者在就诊时的预期寿命以下（bLEP）和预期寿命以上（aLEP）组。使用剩余寿命来计算净寿命年增益（NYLG）。

结果

共有 462 名患者接受 EL：20%在 aLEP 组。这些患者年龄较大（P < 0.001），合并症较多（P < 0.001），P-POSSUM 评分高风险（P = 0.008）。30 天、60 天、90 天和 1 年的死亡率分别为 11%、14%、16%和 23%。高龄（P = 0.011）和高 ASA 评分（P = 0.004）和 P-POSSUM 评分（P < 0.001）是多变量分析中 1 年死亡的独立预测因素。该队列的 NYLG 为 19.2 年。与年龄小于 70 岁的患者相比，年龄 70 岁或以上的患者 NYLG 为 25.9 岁，与 5.5 岁。与 bLEP 和 aLEP 相比，NYLG 为 22.2 岁，与 4.4 岁。在 70 岁及以上的患者中，合并症（ASA 评分 3、4、5）患者的 NYLG 减少了一半以上（9.3 岁，4.3 岁）。