Takano Yasuhiro, Tsukihara Shu, Kai Wataru, Ito Daisuke, Kanno Hironori, Son Kyonsu, Hanyu Nobuyoshi, Eto Ken
Department of Surgery Tokyo General Hospital Nakano-ku Japan.
Department of Surgery The Jikei University School of Medicine Minato-ku Japan.
Ann Gastroenterol Surg. 2022 Feb 12;6(4):587-593. doi: 10.1002/ags3.12558. eCollection 2022 Jul.
Frailty assessment in elderly patients is crucial to predict the postoperative course, considering that frailty is highly associated with postoperative complications and mortality. The aim of this study was to evaluate the value of osteopenia as a risk factor for severe postoperative complications in elderly patients who underwent emergency gastrointestinal surgery.
This study comprised 103 elderly patients who underwent emergency gastrointestinal surgery. Osteopenia was diagnosed by measuring bone mineral density, which was calculated as the average pixel density in the midvertebral core at the 11th thoracic vertebra on the preoperative plain computed tomography image. We retrospectively investigated the relationship between preoperative osteopenia and severe postoperative complications (Clavien-Dindo classification ≥III). Univariate and multivariate analyses were performed to evaluate the risk factors for severe postoperative complications.
Twenty-three patients (22.3%) developed severe postoperative complications. The optimal cutoff value of bone mineral density for severe postoperative complications was 119.5 Hounsfield unit (HU) and 39 patients (37.9%) were diagnosed with osteopenia. The univariate analysis revealed that the American Society of Anesthesiologists Physical Status of ≥3 ( = .0084), hemoglobin levels ( = .0026), albumin levels ( < .001), sarcopenia ( = .015), and osteopenia ( < .001) were significantly associated with severe postoperative complications. The multivariate analysis showed that osteopenia ( = .014) was an independent risk factor for severe postoperative complications.
Osteopenia may be a risk factor for severe postoperative complications in elderly patients after emergency gastrointestinal surgery.
鉴于衰弱与术后并发症及死亡率高度相关，对老年患者进行衰弱评估对于预测术后病程至关重要。本研究的目的是评估骨质疏松作为接受急诊胃肠手术的老年患者发生严重术后并发症的危险因素的价值。
本研究纳入了103例接受急诊胃肠手术的老年患者。通过测量骨密度来诊断骨质疏松，骨密度通过术前胸部平扫计算机断层扫描图像上第11胸椎椎体中部核心区域的平均像素密度计算得出。我们回顾性研究了术前骨质疏松与严重术后并发症（Clavien-Dindo分级≥III级）之间的关系。进行单因素和多因素分析以评估严重术后并发症的危险因素。
23例患者（22.3%）发生了严重术后并发症。严重术后并发症的骨密度最佳截断值为119.5亨氏单位（HU），39例患者（37.9%）被诊断为骨质疏松。单因素分析显示，美国麻醉医师协会身体状况分级≥3级（P = 0.0084）、血红蛋白水平（P = 0.0026）、白蛋白水平（P < 0.001）、肌肉减少症（P = 0.015）和骨质疏松（P < 0.001）与严重术后并发症显著相关。多因素分析表明，骨质疏松（P = 0.014）是严重术后并发症的独立危险因素。
骨质疏松可能是老年患者急诊胃肠手术后发生严重术后并发症的危险因素。
