Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA.
J Am Geriatr Soc. 2023 Aug;71(8):2430-2440. doi: 10.1111/jgs.18357. Epub 2023 Apr 3.
Relatively little is known about how distressing symptoms change among older persons in the setting of major surgery. Our objective was to evaluate changes in distressing symptoms after major surgery and determine whether these changes differ according to the timing of surgery (nonelective vs. elective), sex, multimorbidity, and socioeconomic disadvantage.
From a prospective longitudinal study of 754 nondisabled community-living persons, 70 years of age or older, 368 admissions for major surgery were identified from 274 participants who were discharged from the hospital from March 1998 to December 2017. The occurrence of 15 distressing symptoms was ascertained in the month before and 6 months after major surgery. Multimorbidity was defined as more than two chronic conditions. Socioeconomic disadvantage was assessed at the individual level, based on Medicaid eligibility, and neighborhood level, based on an area deprivation index (ADI) score above the 80th state percentile.
In the month before major surgery, the occurrence and mean number of distressing symptoms were 19.6% and 0.75, respectively. In multivariable analyses, the rate ratios, denoting proportional increases in the 6 months after major surgery relative to presurgery values, were 2.56 (95% confidence interval [CI], 1.91-3.44) and 2.90 (95% CI, 2.01-4.18) for the occurrence and number of distressing symptoms, respectively. The corresponding values were 3.54 (95% CI, 2.06-6.08) and 4.51 for nonelective surgery (95% CI, 2.32-8.76) and 2.12 (95% CI, 1.53-2.92) and 2.20 (95% CI, 1.48-3.29) for elective surgery; p-values for interaction were 0.030 and 0.009. None of the other subgroup differences were statistically significant, although men had a greater proportional increase in the occurrence and number of distressing symptoms than women.
Among community-living older persons, the burden of distressing symptoms increases substantially after major surgery, especially in those having nonelective procedures. Reducing symptom burden has the potential to improve quality of life and enhance functional outcomes after major surgery.
对于接受大手术后老年人的痛苦症状如何变化，我们知之甚少。我们的目的是评估大手术后痛苦症状的变化，并确定这些变化是否因手术时机（非择期手术与择期手术）、性别、多种合并症和社会经济劣势而有所不同。
从一项对 754 名无残疾、社区居住的 70 岁及以上的老年人进行的前瞻性纵向研究中，我们确定了 274 名参与者中有 368 人因大手术住院，他们于 1998 年 3 月至 2017 年 12 月期间出院。在大手术前 1 个月和 6 个月后确定了 15 种痛苦症状的发生情况。多种合并症的定义为两种以上慢性疾病。社会经济劣势在个体层面上根据医疗补助资格评估，在社区层面上根据区域剥夺指数（ADI）得分高于州第 80 百分位数评估。
在大手术前 1 个月，痛苦症状的发生率和平均数量分别为 19.6%和 0.75。在多变量分析中，6 个月后与术前相比的发生率比值（表示手术后痛苦症状的比例增加）分别为 2.56（95%置信区间[CI]，1.91-3.44）和 2.90（95%CI，2.01-4.18），分别为痛苦症状的发生率和数量。相应的值分别为非择期手术（95%CI，2.06-6.08）和 3.54（95%CI，2.32-8.76），以及择期手术（95%CI，1.53-2.92）和 2.12（95%CI，1.48-3.29）和 2.20（95%CI，1.48-3.29）；p 值为 0.030 和 0.009。虽然男性痛苦症状的发生率和数量的增加比例大于女性，但其他亚组差异没有统计学意义。
在社区居住的老年人中，大手术后痛苦症状的负担显著增加，尤其是在接受非择期手术的患者中。减轻症状负担有可能改善大手术后的生活质量并增强功能结局。
