“老年外科手术”：对接受腹部大手术老年患者多维评估量表的评估。最佳预测模型是什么？
"Gerontosurgery": Evaluation of Multidimensional Assessment Scales for Elderly Patients Undergoing Major Abdominal Surgery. What Is the Best Prediction Model?
作者信息
Goglia Marta, Ronconi Diana, DE Zanna Andrea, Cicolani Arianna, Gallo Gaetano, Petrucciani Niccolò, Pavone Matteo, D'Angelo Francesco, Nigri Giuseppe, Aurello Paolo
机构信息
Department of Medical and Surgical Sciences and Translational Medicine, School in Translational Medicine and Oncology, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy;
Department of Surgery, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
出版信息
In Vivo. 2025 Jul-Aug;39(4):2410-2418. doi: 10.21873/invivo.14040.
BACKGROUND/AIM: The aging population poses unique challenges in oncogeriatric surgery, particularly regarding risk stratification and postoperative outcome prediction. The impact of frailty on surgical decision-making reports should be noted. Geriatric assessment scales are recommended for preoperative objective evaluations to optimize surgical outcomes, but their accuracy remains unclear. This study evaluates the effectiveness of five multidimensional geriatric assessment scales - Charlson Comorbidity Index (CCI), APACHE II, Cumulative Illness Rating Scale (CIRS), Identification of Seniors at Risk (ISAR), and G8 - in predicting postoperative complications in elderly patients undergoing major oncological surgery.
PATIENTS AND METHODS
A retrospective observational study was conducted on 69 patients aged ≥75 years who underwent major abdominal surgery for neoplastic conditions between December 2018 and July 2020. Preoperative assessments using the five scoring systems were performed, and postoperative complications were classified according to the Clavien-Dindo system. The study compared the predictive validity of each scale through correlation analysis with postoperative outcomes.
RESULTS
The study found weak correlations between predictive scores and postoperative complications. The G8 scale showed the strongest association with Clavien-Dindo scores (=0.267, =0.027), while other scales exhibited limited predictive value. Despite the widespread use of these scales in clinical practice, none of them accurately predicted postoperative morbidity in this cohort of patients.
CONCLUSION
This study highlights the limitations of existing geriatric assessment scales in predicting postoperative complications for elderly patients undergoing major oncological surgery. Among the evaluated tools, only the G8 score showed an association with complications. However, the results suggest a need for more tailored risk stratification models that incorporate comorbidities, frailty, nutritional status, and physiological reserves. Further research with larger sample sizes is necessary to validate these findings and improve preoperative decision-making in geriatric oncologic surgery.
背景/目的：老龄化人口给肿瘤老年外科带来了独特的挑战，尤其是在风险分层和术后结果预测方面。应注意衰弱对手术决策报告的影响。建议使用老年评估量表进行术前客观评估，以优化手术结果，但其准确性仍不明确。本研究评估了五种多维老年评估量表——查尔森合并症指数（CCI）、急性生理与慢性健康状况评分系统II（APACHE II）、累积疾病评分量表（CIRS）、高危老年人识别量表（ISAR）和G8——在预测接受重大肿瘤手术的老年患者术后并发症方面的有效性。
患者与方法
对2018年12月至2020年7月期间因肿瘤疾病接受重大腹部手术的69例年龄≥75岁的患者进行了一项回顾性观察研究。使用这五种评分系统进行术前评估，并根据Clavien-Dindo系统对术后并发症进行分类。该研究通过与术后结果的相关性分析比较了每种量表的预测效度。
结果
该研究发现预测分数与术后并发症之间的相关性较弱。G8量表与Clavien-Dindo评分的相关性最强（=0.267，=0.027），而其他量表的预测价值有限。尽管这些量表在临床实践中广泛使用，但在这组患者中，没有一个量表能准确预测术后发病率。
结论
本研究强调了现有老年评估量表在预测接受重大肿瘤手术的老年患者术后并发症方面的局限性。在所评估的工具中，只有G8评分与并发症有关联。然而，结果表明需要更具针对性的风险分层模型，该模型应纳入合并症、衰弱、营养状况和生理储备。需要进行更大样本量进一步研究以验证这些发现，并改善老年肿瘤外科手术的术前决策。
Zotero 插件