Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
Surg Endosc. 2023 Nov;37(11):8644-8654. doi: 10.1007/s00464-023-10270-z. Epub 2023 Jul 26.
With an aging population, the utility of surgery in elderly patients, particularly octogenarians, is of increasing interest. The goal of this study was to analyze outcomes of octogenarians versus non-octogenarians undergoing paraesophageal hernia repair (PEHR).
The Nationwide Readmission Database was queried for patients > 18 years old who underwent PEHR from 2016 to 2018. Exclusion criteria included a diagnosis of gastrointestinal malignancy or a concurrent bariatric procedure. Patients ≥ 80 were compared to those 18-79 years old using standard statistical methods, and subgroup analyses of elective and non-elective PEHRs were performed.
From 2016 to 2018, 46,450 patients were identified with 5425 (11.7%) octogenarians and 41,025 (88.3%) non-octogenarians. Octogenarians were more likely to have a non-elective operation (46.3% vs 18.2%, p < 0.001), and those undergoing non-elective PEHR had a higher mortality (5.5% vs 1.2%, p < 0.001). Outcomes were improved with elective PEHR, but octogenarians still had higher mortality (1.3% vs 0.2%, p < 0.001), longer LOS (3[2, 5] vs 2[1, 3] days, p < 0.001), and higher readmission rates within 30 days (11.1% vs 6.5%, p < 0.001) compared to non-octogenarian elective patients. Multivariable logistic regression showed that being an octogenarian was not independently predictive of mortality (odds ratio (OR) 1.373[95% confidence interval 0.962-1.959], p = 0.081), but a non-elective operation was (OR 3.180[2.492-4.057], p < 0.001). Being an octogenarian was a risk factor for readmission within 30 days (OR 1.512[1.348-1.697], p < 0.001).
Octogenarians represented a substantial proportion of patients undergoing PEHR and were more likely to undergo a non-elective operation. Being an octogenarian was not an independent predictor of perioperative mortality, but a non-elective operation was. Octogenarians' morbidity and mortality was reduced in elective procedures but was still higher than non-octogenarians. Elective PEHR in octogenarians is reasonable but should involve a thorough risk-benefit analysis.
随着人口老龄化，手术在老年患者（尤其是 80 岁以上的患者）中的应用越来越受到关注。本研究的目的是分析 80 岁以上患者与非 80 岁以上患者行食管裂孔疝修补术（PEHR）的结局。
从 2016 年至 2018 年，全国再入院数据库中检索了 18 岁以上行 PEHR 的患者。排除标准包括胃肠道恶性肿瘤或同时行减重手术。80 岁以上患者与 18-79 岁患者比较采用标准统计学方法，对择期和非择期 PEHR 进行亚组分析。
2016 年至 2018 年，共纳入 46450 例患者，其中 5425 例（11.7%）为 80 岁以上患者，41025 例（88.3%）为 18-79 岁患者。80 岁以上患者更可能行非择期手术（46.3%比 18.2%，p<0.001），行非择期 PEHR 的患者死亡率更高（5.5%比 1.2%，p<0.001）。择期 PEHR 可改善结局，但 80 岁以上患者死亡率仍较高（1.3%比 0.2%，p<0.001），住院时间更长（3[2，5]比 2[1，3]天，p<0.001），30 天内再入院率更高（11.1%比 6.5%，p<0.001）。与非 80 岁以上择期患者相比。多变量逻辑回归显示，80 岁以上不是死亡率的独立预测因素（优势比（OR）1.373[95%置信区间 0.962-1.959]，p=0.081），但非择期手术是（OR 3.180[2.492-4.057]，p<0.001）。80 岁以上是 30 天内再入院的危险因素（OR 1.512[1.348-1.697]，p<0.001）。
80 岁以上患者在接受 PEHR 的患者中占很大比例，更可能行非择期手术。80 岁以上不是围手术期死亡率的独立预测因素，但非择期手术是。择期手术可降低 80 岁以上患者的发病率和死亡率，但仍高于非 80 岁以上患者。80 岁以上患者行择期 PEHR 是合理的，但应进行彻底的风险-获益分析。
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