Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac094.
Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery.
This was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes.
A total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility.
Increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan.
老年患者在接受手术治疗后，功能恢复延迟的风险较高。本研究旨在确定预测结肠癌手术后 1 年日常生活活动和移动能力水平变化的因素。
这是一项符合 STROBE 指南的多中心观察性研究。前瞻性数据包括术前和术后的移动能力和日常生活活动支持需求、合并症、肿瘤老年综合评估量表（G8）、临床虚弱量表（CFS）、手术数据和术后手术结果。
共招募了 167 名年龄在 80 岁及以上的结肠癌患者。手术后，所有患者中有 30%和 22%的人需要更多的支持，移动能力下降。对所有患者进行多变量分析表明，术前在家外日常生活活动的支持（OR 3.23，95%置信区间 1.06 至 9.80，P=0.039）与随访时的支持增加相关。认知障碍史（3.15，1.06 至 9.34，P=0.038）、血红蛋白<120g/L（7.48，1.97 至 28.4，P=0.003）和出院至其他医疗机构（4.72，1.39 至 16.0，P=0.013）与移动能力下降独立相关。对于功能独立的患者，血红蛋白<120g/L（8.31，1.76 至 39.2，P=0.008）和出院至其他医疗机构（4.38，1.20 至 16.0，P=0.026）与移动能力下降相关。
术前需要更多的支持、认知障碍、术前贫血和出院至其他医疗机构预测结肠癌手术后 1 年需要更多的支持或移动能力下降。术前评估和优化应侧重于纠正贫血、营养状况和移动能力，并制定详细的康复计划。
