Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, 137889University of Maryland Medical Center, Baltimore, MD, USA.
National Study Center for Trauma and Emergency Medical Systems, Center for Shock, Trauma and Anesthesiology Research, 12264University of Maryland School of Medicine, Baltimore, MD, USA.
Am Surg. 2022 Mar;88(3):439-446. doi: 10.1177/00031348211048838. Epub 2021 Nov 3.
Older adults (OAs) 65 years of age, representing the fastest growing segment in the United States, are anticipated to require a greater percentage of emergency general surgery procedures (EGSPs) with an associated increase in health care costs. The aims of this study were to identify the frequency of EGSP and charges incurred by OA compared to their younger counterparts in the state of Maryland.
A retrospective review of the Maryland Health Services Cost Review Commission from 2009 to 2018 was undertaken. Patients undergoing urgent or emergent ESGP were divided into 2 groups (18-64 years and ≥65 years). Data collected included demographics, APR-severity of illness (SOI), APR-risk of mortality (ROM), the EGSP (partial colectomy [PC], small bowel resection [SBR], cholecystectomy, operative management of peptic ulcer disease, lysis of adhesions, appendectomy, and laparotomy), length of stay (LOS), and hospital charges. -values ( < .05) were significant.
Of the 181,283 patients included in the study, 55,401 (38.1%) were ≥65 years of age. Older adults presented with greater APR-SOI (major 37.7% vs 21.3%, extreme 5.2% vs 9.3%), greater APR-ROM (major 25.3% vs 8.7%, extreme 22.3% vs 5.3%), underwent PC (24.5% vs 10.9%) and SBR (12.8% vs 7.0%) more frequently, and incurred significantly higher median hospital charges for every EGSP, consistently between 2009 and 2018 due to increased LOS and complications when compared to those ≤65 years of age.
These findings stress the need for validated frailty indices and quality improvement initiatives focused on the care of OAs in emergency general surgery to maximize outcomes and optimize cost.
美国增长最快的群体是 65 岁以上的老年人，预计他们将需要更多比例的急诊普通外科手术（EGSP），这将导致医疗保健费用的增加。本研究的目的是确定马里兰州老年人与年轻患者相比，进行 EGSP 的频率和费用。
回顾性分析 2009 年至 2018 年马里兰州卫生服务成本审查委员会的数据。将接受紧急或紧急 ESGP 的患者分为 2 组（18-64 岁和≥65 岁）。收集的数据包括人口统计学资料、APR-疾病严重程度（SOI）、APR-死亡率风险（ROM）、EGSP（部分结肠切除术[PC]、小肠切除术[SBR]、胆囊切除术、消化性溃疡病的手术治疗、粘连松解术、阑尾切除术和剖腹术）、住院时间（LOS）和医院费用。P 值（<0.05）有统计学意义。
在纳入研究的 181283 例患者中，55401 例（38.1%）≥65 岁。老年人的 APR-SOI 更高（主要 37.7%比 21.3%，极端 5.2%比 9.3%），APR-ROM 更高（主要 25.3%比 8.7%，极端 22.3%比 5.3%），更频繁地进行 PC（24.5%比 10.9%）和 SBR（12.8%比 7.0%），并且由于 LOS 增加和并发症比≤65 岁的患者，每项 EGSP 的中位医院费用显著更高，从 2009 年到 2018 年一直如此。
这些发现强调需要验证老年人脆弱性指数，并开展质量改进计划，重点关注急诊普通外科手术中老年人的护理，以最大限度地提高治疗效果并优化成本。
