Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
World J Surg. 2022 Nov;46(11):2788-2796. doi: 10.1007/s00268-022-06716-5. Epub 2022 Sep 6.
As society ages, an increasing number of elderly patients require hepato-pancreato-biliary (HPB) surgery. We investigated the risk factors for complications in elderly patients undergoing HPB surgery using surgical risk scoring models.
We retrospectively investigated 184 elderly patients (≥ 65 years old) who underwent HPB surgery, including the liver, pancreas, bile duct, and/or gallbladder resection, with exemption to simple cholecystectomy between January 2017 and December 2019. The surgical risk scoring models used included the Estimation of Physiological Ability and Surgical Stress (E-PASS), Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), and Geriatric 8 (G8). We evaluated the correlations between the scores and severe complications. Complications were classified as severe (Clavien-Dindo classification [C-D] ≥ III) or non-severe (C-D ≤ II).
Complications occurred in 78 patients (24 C-D ≥ III, 54 C-D ≤ II). Preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were significantly higher in patients with C-D ≥ IIIa than in those with C-D ≤ II. Multiple logistic regression analysis revealed that PRS (P = 0.01) and SSS (P = 0.04) were independent predictive factors for severe complications. However, the POSSUM and G8 models showed no significant correlations to severe complications.
E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.
随着社会老龄化，越来越多的老年患者需要接受肝胆胰（HPB）手术。我们使用手术风险评分模型研究了老年 HPB 手术患者发生并发症的危险因素。
我们回顾性调查了 2017 年 1 月至 2019 年 12 月期间接受 HPB 手术的 184 名老年患者（≥65 岁），包括肝、胰、胆管和/或胆囊切除术，但不包括单纯胆囊切除术。使用的手术风险评分模型包括生理能力和手术应激估计（E-PASS）、生理和手术严重程度评分用于死亡率和发病率的计数（POSSUM）和老年 8 分（G8）。我们评估了评分与严重并发症之间的相关性。并发症分为严重（Clavien-Dindo 分级[C-D]≥III）和非严重（C-D≤II）。
78 例患者发生并发症（24 例 C-D≥III，54 例 C-D≤II）。C-D≥IIIa 患者的术前风险评分（PRS）、手术应激评分（SSS）和综合风险评分（CRS）明显高于 C-D≤II 患者。多因素逻辑回归分析显示，PRS（P=0.01）和 SSS（P=0.04）是严重并发症的独立预测因素。然而，POSSUM 和 G8 模型与严重并发症无显著相关性。
E-PASS 是预测老年患者接受 HPB 手术并发症的有用模型。
