Postoperative complications in elderly patients after lung cancer surgery
Postoperative complications in elderly patients after lung cancer surgery
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DOI：
10.1093/icvts/ivt034
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发表时间：
2013-06-01
影响因子：
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通讯作者：
Sato, Toru
中科院分区：
文献类型：
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作者：
Shiono, Satoshi;Abiko, Masami;Sato, Toru
本研究的目的是确定老年肺癌患者术后并发症的危险因素。这些并发症在老年患者中仍然高于年轻患者，降低其发生率是一个重要的目标。我们特别调查了手术因素，包括手术时间、失血量和开胸长度。2000年1月至2009年9月，567例患者在我们机构接受了肺癌手术。我们回顾性分析了119例接受肺叶切除术的患者的记录，这些患者年龄≥ 75岁，可能的术后并发症风险因素。患者的中位年龄为77岁（范围，75-88岁）;其中79例男性和40例女性。无围手术期或术后死亡。术后并发症41例（34.5%），其中心律失常17例（14.3%），持续漏气10例（8.4%），谵妄10例（8.4%），肺炎8例（6.7%），缺氧4例（3.4%），脑血管病2例（1.7%），术后出血1例（0.8%）。单因素分析显示，术后并发症的危险因素包括手术时间较长（P = 0.002）、出血量（P = 0.021）和2004年5月之前接受手术（P = 0.002）。多因素分析显示，手术时间（P = 0.041）和2004年5月以前手术（P = 0.008）是术后并发症的独立危险因素，说明手术质量是决定术后并发症风险的重要因素。严重的粘连和肺部炎症是肺癌手术困难的条件;老年患者需要熟练和细致的手术技术。
The purpose of this study was to identify the risk factors for postoperative complications in elderly patients undergoing lung cancer surgery. These complications remain higher in elderly patients than in young patients, and decreasing their incidence is an important goal. We investigated surgical factors in particular, including surgical time, blood loss and thoracotomy length.Between January 2000 and September 2009, 567 patients underwent lung cancer surgery at our institution. We retrospectively reviewed the records of 119 patients who underwent lobectomy, aged 75 years or older, for possible postoperative complication risk factors.The patients' median age was 77 years (range, 75-88 years); there were 79 men and 40 women. There were no perioperative or postoperative deaths. Postoperative complications developed in 41 (34.5%) patients, including 17 (14.3%) with arrhythmia, 10 (8.4%) with prolonged air leak, 10 (8.4%) with delirium, 8 (6.7%) with pneumonia, 4 (3.4%) with hypoxia, 2 (1.7%) with cerebrovascular disease and 1 (0.8%) with postoperative haemorrhage. Univariate analysis showed that the risk factors for postoperative complications consisted of longer surgery time (P = 0.002), blood loss (P = 0.021) and undergoing surgery prior to May 2004 (P = 0.002). Multivariate analysis revealed that surgery time (P = 0.041) and surgery prior to May 2004 (P = 0.008) were independent risk factors for postoperative complications.This study demonstrates that the quality of surgery is an important factor in determining the risk of postoperative complications. Severe adhesions and lung inflammation are conditions that make lung cancer surgery difficult; a skillful and meticulous surgical technique is required in elderly patients.