Grüßer Linda, Coburn Mark, Schmid Matthias, Rossaint Rolf, Ziemann Sebastian, Kowark Ana
Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, North Rhine-Westphalia, Germany.
Acta Anaesthesiol Scand. 2025 Apr;69(4):e70021. doi: 10.1111/aas.70021.
The number of older patients undergoing surgical procedures with anaesthesia care is projected to rise. In order to cope with the increased demand, the expansion of outpatient surgery may play a decisive role. We aim to investigate the characteristics and outcomes of the older outpatient population.
The Peri-interventional Outcome Study in the Elderly in Europe (POSE) was a prospective multicenter study investigating characteristics and outcomes in 9497 patients aged 80 years and older undergoing a procedure with anaesthesia care. This secondary analysis of the POSE data investigated characteristics, functional and cognitive outcomes, and mortality in the outpatient in comparison to the inpatient population. Functional status was assessed as independent, partially dependent, and totally dependent at baseline and 30 days postinterventional. Cognitive status was defined by the number of recalled words (0-3) in the Mini-Cog test and brief cognitive screening at baseline and follow-up.
Out of the 9497 older patients, 7562 were planned inpatients and 1935 planned outpatients. Older outpatients presented with fewer comorbidities and fewer medications than older inpatients and underwent minor procedures more often Their baseline functional status was more often independent, and they had a higher estimated probability of staying independent. Outpatients recalled three words at baseline and follow-up more often than inpatients. The estimated 30-day survival probabilities with 95% confidence intervals were 0.997 [0.994; 0.999] in the group with planned outpatient surgery and 0.948 [0.942; 0.953] with planned inpatient surgery.
Our results indicate that functional and cognitive status at baseline and follow-up were higher in planned outpatients than in planned inpatients. However, only short screening tools for the assessment of functional and cognitive status were used. Overall, outpatient interventions were associated with low mortality. Further research is recommended to develop scores that facilitate the identification of patients suitable for outpatient surgery.
This secondary analysis of a prospectively collected cohort of elderly surgical cases in Europe describes case factors related to inpatient compared to outpatient surgical interventions. The findings show that inpatient or outpatient surgery selection is associated with different degrees of risk for important perioperative outcomes in this cohort.
预计接受麻醉护理手术的老年患者数量将会增加。为了应对不断增长的需求，扩大门诊手术可能会起到决定性作用。我们旨在调查老年门诊患者的特征和手术结果。
欧洲老年围手术期结局研究（POSE）是一项前瞻性多中心研究，调查了9497名80岁及以上接受麻醉护理手术患者的特征和手术结果。对POSE数据的这项二次分析调查了门诊患者与住院患者相比的特征、功能和认知结果以及死亡率。在基线和干预后30天评估功能状态，分为独立、部分依赖和完全依赖。认知状态通过简易认知测试（Mini-Cog）中回忆单词的数量（0 - 3个）以及基线和随访时的简短认知筛查来定义。
在9497名老年患者中，7562名计划住院，1935名计划门诊。老年门诊患者的合并症和用药比老年住院患者少，且更常接受小手术。他们的基线功能状态更常为独立状态，且保持独立的估计概率更高。门诊患者在基线和随访时比住院患者更常能回忆起三个单词。计划门诊手术组的估计30天生存概率及95%置信区间为0.997[0.994; 0.999]，计划住院手术组为0.948[0.942; 0.953]。
我们的结果表明，计划门诊患者在基线和随访时的功能和认知状态高于计划住院患者。然而，仅使用了评估功能和认知状态的简短筛查工具。总体而言，门诊干预的死亡率较低。建议进一步研究开发有助于识别适合门诊手术患者的评分系统。
这项对欧洲前瞻性收集的老年外科病例队列的二次分析描述了与住院手术干预相比门诊手术干预相关的病例因素。研究结果表明，在该队列中，住院或门诊手术的选择与围手术期重要结局的不同风险程度相关。
