Jehan Faisal S, Alizai Qaider, Powers Mary T, Khreiss Mohammad, Joseph Bellal, Aziz Hassan
Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
J Gastrointest Surg. 2024 Sep;28(9):1505-1511. doi: 10.1016/j.gassur.2024.06.023. Epub 2024 Jul 2.
Both cognitive impairment/dementia (CID) and falls occur more commonly in older adults than in younger patients. This study aimed to analyze the association of a history of CID or falls with the postoperative outcomes of older adults undergoing major intra-abdominal surgeries on a national level.
We retrospectively analyzed the American College of Surgeons-National Surgical Quality Improvement Program 2022 Participant Use Data File. Our primary outcome was postoperative mortality. Statistical analysis was performed using the Chi-square test and multivariate regression analysis.
On multivariable regression analyses, a history of both CID (odds ratio [OR] = 1.9; CI: 1.5-2.5; P < .01) and a fall (OR = 1.8; CI: 1.4-2.3; P < .01) were independently associated with higher adjusted odds of mortality. History of CID or falls was also a predictor of overall complications, major complications, and discharge to a care facility.
A history of CID or falls in older adults before major intra-abdominal surgeries was associated with a high risk of postoperative mortality and morbidity. Further studies are required to establish the causal relation of these factors and the steps to mitigate the risk of associated adverse outcomes.
认知障碍/痴呆（CID）和跌倒在老年人中比在年轻患者中更常见。本研究旨在在全国范围内分析CID病史或跌倒史与接受大型腹部手术的老年人术后结局之间的关联。
我们回顾性分析了美国外科医师学会-国家外科质量改进计划2022参与者使用数据文件。我们的主要结局是术后死亡率。使用卡方检验和多变量回归分析进行统计分析。
在多变量回归分析中，CID病史（比值比[OR]=1.9；可信区间：1.5-2.5；P<.01）和跌倒史（OR=1.8；可信区间：1.4-2.3；P<.01）均与调整后的较高死亡几率独立相关。CID病史或跌倒史也是总体并发症、主要并发症以及转至护理机构的预测因素。
在进行大型腹部手术前，老年人的CID病史或跌倒史与术后高死亡率和发病率相关。需要进一步研究以确定这些因素的因果关系以及降低相关不良结局风险的措施。
