Emergency laparotomy in the older patient: factors predictive of 12-month mortality-Salford-POPS-GS. An observational study.
Emergency laparotomy in the older patient: factors predictive of 12-month mortality-Salford-POPS-GS. An observational study.
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老年患者的紧急剖腹手术：可预测12个月死亡率 - 萨尔福德 - pops-gs的因素。观察性研究。
DOI：
10.1007/s40520-020-01578-0
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发表时间：
2020-11
影响因子：
4
通讯作者：
Pearce L
中科院分区：
文献类型：
--
作者：
Vilches-Moraga A;Rowley M;Fox J;Khan H;Paracha A;Price A;Pearce L
虽然在接受急诊剖腹手术（EL）的老年患者中有较高的院内死亡率，但对这一人群的长期结局知之甚少。我们描述了入院时影响老年患者12个月生存率的因素。对2014年9月8日至2017年3月30日期间在我院接受EL的75岁及以上患者进行的观察性研究。共纳入113例患者。平均年龄为81.9 ± 4.7岁，女性占多数（60/113），3例（2.6%）住在护理院，103例（91.2%）和79例（69.1%）独立于个人和工具性日常生活活动（ADL），8例（7.1%）有认知障碍。中位住院时间为16 ± 29.9天（0-269）;住院死亡率为22.1%（25/113），术后30天、90天和12个月死亡率分别为19.5%（22）、24.8%（28）和38.9%（44）。30-日和12个月再入院率分别为5.7%（5/88）和40.9%（36）。12-使用临床虚弱量表（CFS）评分（64% 5-8 vs 31.7% 1-4，p = 0.006），虚弱患者的1个月再入院率较高。个人ADL依赖性（6/10（60%）依赖性vs. 38/103（36.8%）独立性，p = 0.119）和认知损害（5/8（62.5%）受损vs. 39/105（37.1%）无损害，p = 0.116）显示12个月死亡率较高的趋势。在多变量分析中，12个月死亡率与CFS 5-9（HR 5.0403（95% CI 1.719-16.982）和阿萨III-V级（HR 2.704 95% CI 1.032-7.081））密切相关。虚弱和高阿萨分级可预测急诊剖腹术后12个月死亡率增加。我们提倡早期参与多专业团队在围手术期护理老年患者的经验。
Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.
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影响因子：
6.7
作者：
Hewitt, J.;Carter, B.;Myint, P. K.
通讯作者：
Myint, P. K.
DOI：
10.1111/j.1532-5415.1983.tb03391.x
发表时间：
1983-01-01
影响因子：
6.3
作者：
KATZ, S
通讯作者：
KATZ, S
影响因子：
4
作者：
Vilches-Moraga A;Fox J
通讯作者：
Fox J
影响因子：
8.8
作者：
Soares, Marcio;Caruso, Pedro;Salluh, Jorge I. F.
通讯作者：
Salluh, Jorge I. F.
影响因子：
14.6
作者：
Rockwood, K;Song, XW;Mitnitski, A
通讯作者：
Mitnitski, A