Age is associated with increased morbidity after laparoscopic appendectomy.
Age is associated with increased morbidity after laparoscopic appendectomy.
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DOI：
10.1016/j.surg.2022.04.008
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发表时间：
2022-08
期刊：
影响因子：
3.8
通讯作者：
Balentine, Courtney
中科院分区：
文献类型：
--
作者：
Stevens, Audrey;Meier, Jennie;Bhat, Archana;Bhat, Sneha;Balentine, Courtney
腹腔镜阑尾切除术是美国最常见的急诊普通外科手术之一。对于老年人的术后结果知之甚少，因为阑尾炎通常发生在年轻患者中。本研究的目的是探讨年龄与阑尾切除术后并发症之间的关系。我们假设年龄与发病率有显著的非线性相关。我们对退伍军人事务部（VA）手术质量改进计划（2000-2018; n = 14，619）和国家手术质量改进计划（2005-2019; n = 349，909）数据库中记录的腹腔镜阑尾切除术的个人进行了回顾性队列研究。主要结局为30天发病率。我们使用分数多项式逻辑回归模型年龄和结果之间的非线性关系。非退伍军人队列的中位年龄（四分位距）为36岁（26-51岁; 8.4%的患者年龄为65岁或以上），而退伍军人队列的中位年龄为51岁（35-63岁; 21%的患者年龄为65岁或以上）。对于退伍军人和非退伍军人，有一个显着的和非线性的关系，年龄和并发症的风险。在非退伍军人队列中，术后并发症的预测概率（95%置信区间）在65岁时为9.8%（9.7-10.1），在75岁时为11.9%（11.7-12.3），在85岁时为14.5%（14.1-14.9）。在退伍军人中，65岁时的风险为7.5%（6.9-8.1），75岁时为8.3%（7.6-9.1），85岁时为9.1%（8.1-10.1）。对于退伍军人和非退伍军人，年龄较大与术后并发症的风险显着增加。值得注意的是，VA内的老年人发病率低于非VA医院。
Laparoscopic appendectomy is one of the most common emergency general surgery procedures in the United States. Little is known about its postoperative outcomes for older adults because appendicitis typically occurs in younger patients. The purpose of this study was to examine the association between age and postoperative complications after appendectomy. We hypothesized that age would have a significant and nonlinear association with morbidity. We conducted a retrospective cohort study of individuals whose laparoscopic appendectomies were recorded in the Veterans Affairs (VA) Surgical Quality Improvement Program (from 2000–2018; n = 14,619) and National Surgical Quality Improvement Program (2005–2019; n = 349,909) databases. The primary outcome was 30-day morbidity. We used logistic regression with fractional polynomials to model nonlinear relationships between age and outcomes. The median age (interquartile range) of the nonveteran cohort was 36 years (26–51; 8.4% of patients were 65 or older) versus 51 years among veterans (35–63; 21% were 65 or older). For veterans and nonveterans, there was a significant and nonlinear relationship between age and risk of complications. In the nonveteran cohort, the predicted probability (with 95% confidence interval) of postoperative complications was 9.8% (9.7–10.1) at age 65, 11.9% (11.7–12.3) at age 75, and 14.5% (14.1–14.9) at age 85. Among veterans, the risk was 7.5% (6.9–8.1) at age 65, 8.3% (7.6–9.1) at age 75, and 9.1% (8.1–10.1) at age 85. For both veterans and nonveterans, older age was associated with a significantly increased risk of postoperative complications. Notably, morbidity within the VA was lower for older adults than in non-VA hospitals.
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影响因子：
2.6
作者：
Kirshtein, Boris;Perry, Zvi Howard;Lantsberg, Leonid
通讯作者：
Lantsberg, Leonid
影响因子：
--
作者：
Massarweh, Nader N.;Legner, Victor J.;Flum, David R.
通讯作者：
Flum, David R.
影响因子：
4.8
作者：
Royston, Patrick;Sauerbrei, Willi
通讯作者：
Sauerbrei, Willi
DOI：
10.4293/jsls.2020.00046
发表时间：
2020-07-01
影响因子：
1.5
作者：
Weinandt, Marthe;Godiris-Petit, Gaelle;Lupinacci, Renato Micelli
通讯作者：
Lupinacci, Renato Micelli
影响因子：
5
作者：
ADDISS, DG;SHAFFER, N;TAUXE, RV
通讯作者：
TAUXE, RV