Kent Ilan, Ghuman Amandeep, Sadran Luna, Rov Adi, Lifschitz Guy, Rudnicki Yaron, White Ian, Goldberg Nitzan, Avital Shmuel
Department of Surgery, Meir Medical Center, Kfar Saba 4428164, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel.
J Clin Med. 2023 Mar 23;12(7):2465. doi: 10.3390/jcm12072465.
As the population ages emergency surgeries among the elderly population, including colonic resections, is also increasing. Data regarding the short- and long-term outcomes in this population is scarce.
A retrospective study was performed to investigate mortality and mortality risk factors associated with emergent colectomies in older compared to younger patients in a single university affiliated tertiary hospital. Patients with metastatic disease, colectomy due to trauma or index colectomy within 30 days prior to emergent surgery were excluded.
Operative outcomes compared among age groups, included 30-day mortality, mortality risk-factors and long-term survival. 613 eligible patients were included in the cohort. Mean age was 69.4 years, 45.1% were female. Patients were divided into four age groups: 18-59, 60-69, 70-79 and ≥80-years. Thirty-day mortality rates were 3.2%, 11%, 29.3% and 37.8%, respectively and 22% for the entire cohort. Risk-factors for perioperative death in the younger group were related to severity of ASA score and WBC count. In groups 60-69, 70-79, main risk-factors were ADL dependency and ASA score. In the ≥80 group, risk-factors affecting perioperative mortality, included ASA score, pre-operative albumin, creatinine, WBC levels, cancer etiology, ADL dependency, and dementia. Long-term survival differed significantly between age groups.
Perioperative mortality with emergency colectomy increases with patients' age. Patients older than eighty-years undergoing urgent colectomies have extremely high mortality rates, leading to a huge burden on medical services. Evaluating risk-factors for mortality and pre-operative discussion with patients and families is important. Screening the elderly population for colonic pathologies can result in early diagnosis potentially leading to elective surgeries with decreased mortality.
随着人口老龄化，老年人群中的急诊手术，包括结肠切除术，也在增加。关于该人群短期和长期结局的数据稀缺。
在一家大学附属三级医院进行了一项回顾性研究，以调查老年患者与年轻患者相比，急诊结肠切除术相关的死亡率和死亡风险因素。排除患有转移性疾病、因创伤行结肠切除术或急诊手术前30天内行初次结肠切除术的患者。
比较各年龄组的手术结局，包括30天死亡率、死亡风险因素和长期生存率。队列中纳入了613例符合条件的患者。平均年龄为69.4岁，45.1%为女性。患者分为四个年龄组：18 - 59岁、60 - 69岁、70 - 79岁和≥80岁。30天死亡率分别为3.2%、11%、29.3%和37.8%，整个队列的死亡率为22%。较年轻组围手术期死亡的风险因素与美国麻醉医师协会（ASA）评分的严重程度和白细胞计数有关。在60 - 69岁、70 - 79岁组，主要风险因素是日常生活活动能力（ADL）依赖和ASA评分。在≥80岁组，影响围手术期死亡率的风险因素包括ASA评分、术前白蛋白、肌酐、白细胞水平、癌症病因、ADL依赖和痴呆。各年龄组的长期生存率差异显著。
急诊结肠切除术的围手术期死亡率随患者年龄增加而升高。80岁以上患者行急诊结肠切除术的死亡率极高，给医疗服务带来巨大负担。评估死亡风险因素并与患者及家属进行术前讨论很重要。对老年人群进行结肠病变筛查可实现早期诊断，有可能进行择期手术并降低死亡率。
