Fotopoulou Aikaterini, Garmpis Nikolaos, Keramida Myrto, Mantas Dimitrios
Hippocratio General Hospital of Athens, Greece.
Surgical Department, Sotiria General Hospital, Athens, Greece.
Maedica (Bucur). 2025 Mar;20(1):3-10. doi: 10.26574/maedica.2025.20.1.3.
The global population is aging and life expectancy is increasing rapidly. As a consequence, the need of major abdominal surgeries increases as well. However, due to the advanced age, such surgeries are characterized by high morbidity and mortality rates, which proportionately increase with age.
To investigate perioperative morbidity and mortality rates and identify their relative prognostic factors among elderly and octogenarian patients undergoing major abdominal surgery.
A total of 321 patients who underwent major abdominal surgery in the Second Department of Propaedeutic Surgery of Laiko General Hospital in Athens, Greece, were prospectively reviewed. The sample was divided into two groups. Group A included 254 (79.1%) elderly patients aged 65 to 79 years and Group B, 67 (20.9%) patients aged 80 years and over. Data was collected between June 2021 and June 2024 via patients' medical records using a recording form which included demographic and medical characteristics, morbidity factors such as duration of hospitalization, Dindo-Clavien classification, need of transfer to the intensive care unit (ICU) and survival outcome.
There was no difference in baseline characteristics, including gender (p=0.094) and preoperative ASA (American Society of Anesthesiologists) classification (p=0.096), between the two groups. Absence of comorbidities was found only in Group A (p=0.010), while in Group B there were higher percentages of patients with more than two comorbidities, especially pathological ones (p=0.011), compared with Group A (p=0.006). Regarding the type of surgery (emergency or elective), there was no difference between the two study groups (p>0.05), but colectomy and gastrectomy were more prevalent among patients in Group B, while hepatectomy and pancreatectomy were more prevalent in Group A (p=0.018). We found no difference in perioperative morbidity factors, including duration of hospitalization (p=0.841), the need for ICU transfer (p=0.166) and perioperative complications based on Dindo-Clavien classification (p=0.228). However, fatality rates were higher in Group B than Group A (10.4% vs. 3.5%, p=0.030), with correlation analysis showing a positive correlation between Group B and mortality (rs=0.129, p=0.021), indicating that age ≥80 years was directly affecting mortality. Morbidity factors were found to be independent risk factors of each other (p<0.05) for both study groups and ASA score was a direct predictor for morbidity among octogenarian patients, while the type of surgery was a direct predictor for ICU transfer among the elderly ones (p<0.05). Postoperative complications were a direct predictor of mortality for both groups (p<0.001), while ASA classification (p=0.011) and hospitalization duration (p<0.001) were direct mortality predictors for the elderly subjects and ICU transfer for octogenarian ones (p=0.005).
Advanced age is associated with higher rates of mortality, which in turn is affected by both perioperative morbidity and preoperative ASA scores.
全球人口正在老龄化，预期寿命迅速增加。因此，腹部大手术的需求也在增加。然而，由于年龄较大，此类手术的特点是发病率和死亡率较高，且随着年龄的增长成比例增加。
调查接受腹部大手术的老年和八旬患者围手术期的发病率和死亡率，并确定其相关的预后因素。
对希腊雅典拉伊科综合医院第二普通外科接受腹部大手术的321例患者进行前瞻性研究。样本分为两组。A组包括254例（79.1%）年龄在65至79岁之间的老年患者，B组包括67例（20.9%）年龄在80岁及以上的患者。2021年6月至2024年6月期间，通过患者病历使用一份记录表格收集数据，该表格包括人口统计学和医学特征、发病因素，如住院时间、Dindo-Clavien分类、转入重症监护病房（ICU）的需求和生存结果。
两组之间的基线特征，包括性别（p = 0.094）和术前美国麻醉医师协会（ASA）分级（p = 0.096），没有差异。仅在A组中发现无合并症（p = 0.010），而与A组相比，B组中患有两种以上合并症（尤其是病理性合并症）的患者百分比更高（p = 0.011）（p = 0.006）。关于手术类型（急诊或择期），两个研究组之间没有差异（p>0.05），但结肠切除术和胃切除术在B组患者中更为普遍，而肝切除术和胰腺切除术在A组中更为普遍（p = 0.018）。我们发现围手术期发病因素没有差异，包括住院时间（p = 0.841）、转入ICU的需求（p = 0.166）以及基于Dindo-Clavien分类的围手术期并发症（p = 0.228）。然而，B组的死亡率高于A组（10.4%对3.5%，p = 0.030），相关分析显示B组与死亡率之间存在正相关（rs = 0.129，p = 0.021），表明年龄≥80岁直接影响死亡率。发病因素被发现是两个研究组各自独立的危险因素（p<0.05），ASA评分是八旬患者发病的直接预测因素，而手术类型是老年患者转入ICU的直接预测因素（p<0.05）。术后并发症是两组死亡率的直接预测因素（p<0.001），而ASA分级（p = 0.011）和住院时间（p<0.001）是老年患者死亡率的直接预测因素，转入ICU是八旬患者死亡率的直接预测因素（p = 0.005）。
高龄与较高的死亡率相关，而死亡率又受到围手术期发病率和术前ASA评分的影响。
