Prognostic significance of postoperative in-hospital complications in elderly patients. II. Long-term quality of life.
Prognostic significance of postoperative in-hospital complications in elderly patients. II. Long-term quality of life.
复制标题
老年患者术后院内并发症的预后意义。
DOI：
10.1097/00000539-200302000-00052
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发表时间：
2003
影响因子：
5.7
通讯作者：
Leung,JacquelineM
中科院分区：
文献类型：
--
作者：
Manku,Kawalpreet;Leung,JacquelineM
为了确定非致命性住院术后并发症对长期生活质量和功能状态的影响，我们研究了连续的70岁以上接受非心脏手术的患者。术后2-3年确定非致命性住院术后并发症的发生与长期生活质量（通过医学结局研究简表36测量）和功能状态之间的关系。生活质量和功能状态的独立预测因素采用多因素logistic回归分析。353例患者中有264例（74.8%）对调查做出了回应。在以下领域，有住院术后并发症的患者的平均医疗结局研究简表36评分显著低于无并发症的患者：身体功能（42.8对53.9; P= 0.029），一般健康状况（52.3对62.3; P= 0.02）和角色情感（45.7对67.9; P= 0.00058）。有术后并发症的患者更可能依赖日常生活活动。与年龄匹配的美国人群相比，术后并发症患者的身体功能评分较低（42.8 vs 53.2; P= 0.04），角色（26.6对45.3; P= 0.0078）、角色情感（45.7对63.2; P= 0.025）和心理健康（66对74; P= 0.024）。通过多变量logistic回归分析，只有糖尿病史（比值比4.2; 95%可信区间，1.7-10.3; P< 0.002）和因医疗原因新住院（比值比3.8; 95%可信区间，1.6-8.8; P< 0.002）是生活质量长期下降的重要独立预测因素。调整其他临床因素后，院内并发症不再独立预测功能状态的变化。对于老年患者，术后并发症的发生不能独立预测长期生活质量或功能状态。重要的独立预测因素是合并症、年龄和出院后新住院。
To determine the impact of nonfatal in-hospital postoperative complications on long-term quality of life and functional status, we studied consecutive patients≥ 70 yr of age who had undergone noncardiac surgery. The association between the occurrence of nonfatal in-hospital postoperative complications and long-term quality of life (measured by the Medical Outcome Study Short form 36) and functional status was determined 2–3 yr after surgery. Independent predictors of quality of life and functional status were measured by multivariate logistic regression. Two-hundred-sixty-four of 353 patients (74.8%) responded to the survey. The mean Medical Outcome Study Short form 36 scores of patients with in-hospital postoperative complications were significantly lower than those without complications in the following domains: physical functioning (42.8 versus 53.9; P= 0.029), general health (52.3 versus 62.3; P= 0.02), and role emotional (45.7 versus 67.9; P= 0.00058). Patients who had postoperative complications were more likely to be dependent in daily living activities. Comparison with age-matched United States population showed that patients with postoperative complications had lower scores in physical functioning (42.8 versus 53.2; P= 0.04), role physical (26.6 versus 45.3; P= 0.0078), role emotional (45.7 versus 63.2; P= 0.025), and mental health (66 versus 74; P= 0.024). By multivariate logistic regression analysis, only a history of diabetes (odds ratios 4.2; 95% confidence interval, 1.7–10.3; P< 0.002 and new hospitalization because of medical reasons (odds ratio, 3.8; 95% confidence interval, 1.6–8.8; P< 0.002) were significant independent predictors of a long-term decrease in quality of life. Adjusting for other clinical factors, in-hospital complications no longer independently predicted changes in functional status. For geriatric patients, the occurrence of postoperative complications does not independently predict long-term quality of life or functional status. The important independent predictors are co-morbid conditions, age, and new hospitalization after discharge.