Surgery Department, CHU de Quebec - Laval University, Quebec, Canada.
J Gastrointest Surg. 2023 Aug;27(8):1677-1684. doi: 10.1007/s11605-023-05720-x. Epub 2023 Jul 5.
Surgical interventions in the elderly are becoming more frequent given the aging of the population. Due to their increased vulnerability in an emergent context, we aimed to evaluate various risk factors associated with an early mortality and an unfavorable postoperative trajectory.
We performed a retrospective, single-center cohort study including patients over the age of 75 who underwent emergency colon resection between January 2016 and December 2020.
Among 299 patients included, the type of resection most frequently encountered was right hemicolectomy (34%). Large bowel obstruction was the surgical indication for 61% of patients (n = 182). The mortality rate within 30 days of primary surgery was 14% (n = 42). The main factors having a significant impact on early mortality were the modified Frailty Index (mFI) (26% vs 4%; p < 0.001), Charlson comorbidity index (CCI) (20 vs 0%; p = 0.03) and surgical indication (36% vs 11%; p = 0.03). No statistically significant difference was observed according to the age of the patients. Patients with a higher mFI ([Formula: see text] 3) had an increased risk of early mortality with an odds ratio (OR) of 11.94 (95%CI: 2.38-59.88; p < 0.001) in multivariate analysis. This association was also observed for the secondary outcomes, as patients with a higher mFI were less likely to return home (59% vs 32%; p = 0.009) and have their stoma closured at the end of the follow-up period (94% vs 33%; p < 0.001).
In the geriatric population, the use of mFI is a good predictor of early mortality following an emergency colon resection. This accessible tool could be used to guide the surgical decision-making.
随着人口老龄化，老年患者的手术干预越来越频繁。由于他们在紧急情况下的脆弱性增加，我们旨在评估与早期死亡率和术后不良轨迹相关的各种风险因素。
我们进行了一项回顾性、单中心队列研究，纳入了 2016 年 1 月至 2020 年 12 月期间接受紧急结肠切除术的 75 岁以上患者。
在 299 例患者中，最常遇到的切除术类型是右半结肠切除术（34%）。大肠梗阻是 61%（n=182）患者的手术指征。初次手术后 30 天内的死亡率为 14%（n=42）。对早期死亡率有显著影响的主要因素是改良虚弱指数（mFI）（26%比 4%；p<0.001）、Charlson 合并症指数（CCI）（20 比 0%；p=0.03）和手术指征（36%比 11%；p=0.03）。患者年龄无统计学差异。mFI 较高的患者（[Formula: see text]3）早期死亡的风险增加，多变量分析的优势比（OR）为 11.94（95%CI：2.38-59.88；p<0.001）。在次要结局中也观察到这种关联，mFI 较高的患者更不可能回家（59%比 32%；p=0.009），并且在随访结束时关闭造口的可能性较低（94%比 33%；p<0.001）。
在老年人群中，mFI 是急诊结肠切除术后早期死亡率的良好预测指标。这种易于使用的工具可以用于指导手术决策。
