Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minamiku, Yokohama, 232-0024, Japan.
Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
BMC Geriatr. 2024 Mar 12;24(1):250. doi: 10.1186/s12877-024-04872-y.
An increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure.
In this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis.
During the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p < 0.001). After adjustments for other covariates, laparoscopic surgery was an independent preventive factor for postoperative functional decline (OR, 0.22; 95% CI, 0.05-0.83; p < 0.05).
In emergency abdominal surgery, laparoscopic surgery reduces postoperative physical functional decline in older patients. Widespread use of laparoscopic surgery can potentially preserve patient quality of life and may be important for the better development of emergency abdominal surgery.
越来越多的老年患者需要接受急诊腹部手术来治疗急性腹痛。他们容易受到手术应激的影响，并且在进行日常活动时丧失了独立性。腹腔镜手术具有恢复更快、术后疼痛更少和住院时间更短的优点。然而，很少有研究探讨腹腔镜手术与身体功能下降之间的关系。因此，我们旨在研究身体功能变化与手术方式之间的关系。
这是一项单中心回顾性队列研究，我们纳入了 2019 年 1 月 1 日至 2021 年 12 月 31 日期间因急性腹痛接受急诊腹部手术的年龄≥65 岁的患者。我们使用 Barthel 指数评估他们的日常生活活动能力。术后 28 天与术前相比，Barthel 指数下降≥20 分定义为功能下降。我们使用多因素逻辑回归分析评估老年患者中功能下降与手术方式之间的关系。
在研究期间，有 852 名患者接受了急诊腹部手术。其中，有 280 名患者符合分析条件。其中，94 名患者接受了腹腔镜手术，186 名患者接受了开放手术。术后 28 天，接受腹腔镜手术的患者功能下降程度较低（6%比 49%，p<0.001）。在调整其他协变量后，腹腔镜手术是术后功能下降的独立预防因素（OR，0.22；95%CI，0.05-0.83；p<0.05）。
在急诊腹部手术中，腹腔镜手术可减少老年患者术后身体功能下降。广泛应用腹腔镜手术可能有助于维持患者的生活质量，对于急诊腹部手术的更好发展可能具有重要意义。
