Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients
Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients
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DOI：
10.1001/archsurg.2009.203
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Longo, Walter E.
中科院分区：
文献类型：
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作者：
McGillicuddy, Edward A.;Schuster, Kevin M.;Longo, Walter E.
目的：确定可快速改变的危险因素，以改善接受紧急结直肠手术且发病率和死亡率高风险的老年患者的手术结果。设计：回顾性审查。根据现行程序术语代码和急诊科入院来识别患者。审查医疗记录并提取合并症、手术细节以及院内发病率和死亡率的数据。地点：大学三级转诊中心。患者：292 名 65 岁或以上的患者，从 2000 年 1 月 1 日到 2006 年 12 月 31 日接受紧急结直肠手术。主要结果指标：术后发病率（重症监护室天数、呼吸机）天数、肺炎、深静脉血栓、肺栓塞、心肌梗死和脑血管意外）和死亡率。结果：最常见的诊断是梗阻性或穿孔性结直肠癌（30%）和穿孔性憩室炎（25%）。就诊时的平均年龄为 78.1 岁，院内死亡率为 15%。 101 名患者 (35%) 总共经历了 1.95 种并发症。肺炎（25%）、持续性或复发性呼吸衰竭（15%）和心肌梗塞（12%）是最常见的并发症。手术时间、休克、肾功能不全和明显的腹腔内污染或明显的腹膜炎与发病率相关。年龄、就诊时的感染性休克、术中估计大量失血、手术延误以及并发症的发生与院内死亡率相关。结论：老年人的急诊结直肠手术与显着的发病率和死亡率相关。最大限度地减少最终手术治疗的延误可能会改善结果。这些手术经常涉及局部晚期结直肠癌，强调需要改进结直肠癌筛查。
Objective: To identify rapidly modifiable risk factors that would improve surgical outcomes in elderly patients undergoing emergent colorectal procedures who are at high risk for morbidity and mortality.Design: Retrospective review. Patients were identified on the basis of Current Procedural Terminology codes and admission through the emergency department. Medical records were reviewed and data were abstracted for comorbidities, procedural details, and in-hospital morbidity and mortality.Setting: University tertiary referral center.Patients: Two hundred ninety-two patients 65 years or older undergoing emergency colorectal procedures from January 1, 2000, through December 31, 2006.Main Outcome Measures: Postoperative morbidity (intensive care unit days, ventilator days, pneumonia, deep venous thrombosis, pulmonary embolus, myocardial infarction, and cerebrovascular accident) and mortality.Results: The most frequent presenting diagnoses were obstructing or perforated colorectal carcinoma (30%) and perforated diverticulitis (25%). Average age at presentation was 78.1 years, and in-hospital mortality was 15%. One hundred one patients (35%) experienced a total of 1.95 complications. Pneumonia (25%), persistent or recurrent respiratory failure (15%), and myocardial infarction (12%) were the most frequent complications. Operative time, shock, renal insufficiency, and significant intra-abdominal contamination or frank peritonitis were associated with morbidity. Age, septic shock at presentation, large estimated intraoperative blood loss, delay to operation, and development of a complication were associated with in-hospital mortality.Conclusions: Emergent colorectal procedures in the elderly are associated with significant morbidity and mortality. Minimizing the delay to definitive operative care may improve outcomes. These procedures frequently involve locally advanced colorectal cancer, emphasizing the need for improved colorectal cancer screening.