Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany.
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany.
Int J Colorectal Dis. 2022 Jun;37(6):1281-1288. doi: 10.1007/s00384-022-04152-4. Epub 2022 May 5.
Mechanical bowel obstruction (MBO) is one of the most common indications for emergency surgery. Recent research justifies the method of attempting 3-5 days of nonoperative treatment before surgery. However, little is known about specific characteristics of geriatric patients undergoing surgery compared to a younger cohort. We aimed to analyze patients with MBO that required surgery, depending on their age, to identify potential targets for use in the reduction in complications and mortality in the elderly.
Thirty-day and in-hospital mortality were determined as primary outcome. We retrospectively identified all patients who underwent surgery for MBO at the University Hospital of Bonn between 2009 and 2019 and divided them into non-geriatric (40-74 years, n = 224) and geriatric (≥ 75 years, n = 88) patients, using the chi-squared-test and Mann-Whitney U test for statistical analysis.
We found that geriatric patients had higher 30-day and in-hospital mortality rates than non-geriatric patients. As secondary outcome, we found that they experienced a longer length of stay (LOS) and higher complication rates than non-geriatric patients. Geriatric patients who suffered from large bowel obstruction (LBO) had a higher rate of bowel resection, stoma creation, and a higher 30-day mortality rate. The time from admission to surgery was not shown to be crucial for the outcome of (geriatric) patients.
Geriatric patients suffering from mechanical bowel obstruction that had to undergo surgery had higher mortality and morbidity than non-geriatric patients. Especially in regard to geriatric patients, clinicians should treat patients in a risk-adapted rather than time-adapted manner, and conditions should be optimized before surgery.
机械性肠梗阻（MBO）是急诊手术最常见的指征之一。最近的研究证明，在手术前尝试非手术治疗 3-5 天的方法是合理的。然而，与年轻患者相比，接受手术的老年患者的具体特征知之甚少。我们旨在分析因 MBO 而需要手术的患者，根据他们的年龄，确定潜在的目标，以减少老年患者的并发症和死亡率。
30 天和住院死亡率是主要的研究结果。我们回顾性地确定了 2009 年至 2019 年期间在波恩大学医院因 MBO 接受手术的所有患者，并使用卡方检验和曼-惠特尼 U 检验将他们分为非老年组（40-74 岁，n=224）和老年组（≥75 岁，n=88）。
我们发现老年患者的 30 天和住院死亡率高于非老年患者。作为次要结果，我们发现他们的住院时间（LOS）更长，并发症发生率高于非老年患者。患有大肠梗阻（LBO）的老年患者有更高的肠切除术、造口术和更高的 30 天死亡率。从入院到手术的时间对（老年）患者的结果没有显示出至关重要的影响。
因机械性肠梗阻而接受手术的老年患者的死亡率和发病率高于非老年患者。特别是对于老年患者，临床医生应根据风险而非时间来治疗患者，并且应在手术前优化患者的状况。
