Ostovar Roya, Schröter Filip, Kühnel Ralf-Uwe, Hartrumpf Martin, Albes Johannes Maximilian
Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, "Theodor Fontane", Faculty of Health Sciences Brandenburg, 16321 Bernau, Germany.
J Clin Med. 2022 Nov 23;11(23):6907. doi: 10.3390/jcm11236907.
Objective: Age has an undeniable impact on perioperative mortality. However, it is not necessarily a predictor of frailty per se, as older patients have different outcomes. To verify specific conditions underlying frailty, we examined demographics, comorbidities, frequency, and distribution of postoperative complications influencing outcomes in a challenging cohort of patients undergoing mitral valve surgery. Methods: The study enrolled 1627 patients who underwent mitral valve surgery. Patients younger than 40 years who had been diagnosed with endocarditis were excluded. Patients were divided into three groups with ages ranging from 40−59 (n = 319), 60−74 (n = 795), and >75 years (n = 513). Baseline, comorbidities, postoperative complications, and mortality were recorded. Results: The older the patients were, the more frequently they suffered from pre- and postoperative renal insufficiency (p < 0.001). The likelihood of postoperative renal failure requiring dialysis was significantly higher with pre-existing renal failure. There was a significant association between postoperative renal insufficiency and the development of postoperative pleural or pericardial effusion (p < 0.001, p = 0.016). A significant decrease in BMI was observed in patients >75 years of age compared to the 60−74 years group (27.3 vs. 28.2 kg/m2, p = 0.007). The development of critical illnesses such as myopathy and neuropathy (CIP/CIM) was age-dependent and increased significantly with age (p = 0.04). Hospitalization duration and mortality also increased significantly with age (p = 0.013, p < 0.001). Conclusions: It appears that elderly patients with advanced renal failure have a significantly higher risk of mortality, postoperative renal failure, need for dialysis, and possibly the development of pleural and pericardial effusions in mitral valve surgery. In addition, more frequent CIP/CIM with concomitant decrease in BMI in the most advanced age group indicate sarcopenia and thus an additional feature of frailty besides renal failure.
年龄对围手术期死亡率有着不可否认的影响。然而，年龄本身不一定是虚弱的预测指标，因为老年患者有着不同的预后。为了验证虚弱背后的具体情况，我们在一组接受二尖瓣手术的具有挑战性的患者队列中，研究了影响预后的人口统计学、合并症、术后并发症的发生率及分布情况。方法：该研究纳入了1627例行二尖瓣手术的患者。排除年龄小于40岁且被诊断为心内膜炎的患者。患者被分为三组，年龄范围分别为40 - 59岁（n = 319）、60 - 74岁（n = 795）和>75岁（n = 513）。记录基线情况、合并症、术后并发症及死亡率。结果：患者年龄越大，术前和术后肾功能不全的发生率越高（p < 0.001）。术前存在肾功能衰竭时术后需要透析的肾衰竭可能性显著更高。术后肾功能不全与术后胸腔或心包积液的发生之间存在显著关联（p < 0.001，p = 0.016）。与60 - 74岁组相比，>75岁患者的BMI显著下降（27.3 vs. 28.2 kg/m²，p = 0.007）。诸如肌病和神经病变（CIP/CIM）等危重病的发生与年龄相关，且随年龄显著增加（p = 0.04）。住院时间和死亡率也随年龄显著增加（p = 0.013，p < 0.001）。结论：在二尖瓣手术中，似乎患有晚期肾衰竭的老年患者死亡率、术后肾衰竭、透析需求以及胸腔和心包积液发生的风险显著更高。此外，在最年长的年龄组中，CIP/CIM更频繁且BMI随之下降，表明存在肌肉减少症，因此除肾衰竭外还是虚弱的一个额外特征。
