Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Langenbecks Arch Surg. 2022 Nov;407(7):2937-2944. doi: 10.1007/s00423-022-02592-8. Epub 2022 Jun 27.
Our study analyzes the influence of minimally invasive vs. open surgery on the postoperative need for nursing care in patients with colorectal carcinoma. Colorectal cancer is an age-related disease, and oncologic surgery is increasingly performed in elderly patients. Long-term effects of the procedural choice on patients' self-sufficiency and autonomy have not been scientifically addressed so far.
Multivariable logistic regression models based on claims data from a statutory health insurer (AOK, Baden-Württemberg, Germany) were applied to assess potential risk factors for assignment patients to a nursing care level, a German scale to categorize individual need for nursing care, at 12 and 36 months after colorectal cancer surgery.
A total of 3996 patients were eligible to be included in the analysis. At 36 months postoperatively, 44 of 427 (10.3%) patients after minimally invasive colon cancer surgery and 231 of 1287 (17.9%) patients after open procedure were newly graded into a nursing care level (OR = 0.62, 95%CI = 0.44-0.90, p = 0.010). Thirty-four of 251 (13.5%) patients receiving minimally invasive rectal cancer surgery compared to 142 of 602 (23.6%) patients after open approach were newly assigned to a nursing care level (OR = 0.53, 95%CI = 0.34-0.81, p = 0.003).
Laparoscopically assisted resection of colorectal cancer seems to be superior in preserving physical autonomy of elderly patients with colorectal cancer.
我们的研究分析了微创与开放手术对结直肠癌患者术后护理需求的影响。结直肠癌是一种与年龄相关的疾病，老年患者越来越多地接受肿瘤手术。迄今为止，尚未从科学角度探讨手术方案选择对患者自理能力和自主性的长期影响。
基于法定健康保险公司（AOK，巴登-符腾堡州，德国）的索赔数据，应用多变量逻辑回归模型，评估将患者分配至护理水平（德国护理需求分类量表）的潜在风险因素，该量表用于分类结直肠癌手术后 12 个月和 36 个月的个体护理需求。
共有 3996 例患者符合纳入分析标准。术后 36 个月时，427 例微创结肠癌手术后的患者中有 44 例（10.3%）和 1287 例开腹手术后的患者中有 231 例（17.9%）新分级为护理级别（OR=0.62，95%CI=0.44-0.90，p=0.010）。251 例接受微创直肠癌手术的患者中有 34 例（13.5%）和 602 例开腹手术的患者中有 142 例（23.6%）新分配到护理级别（OR=0.53，95%CI=0.34-0.81，p=0.003）。
腹腔镜辅助结直肠癌切除术在保留老年结直肠癌患者的身体自主性方面似乎更具优势。
