High-Risk Comorbidity Combinations in Older Patients Undergoing Emergency General Surgery
High-Risk Comorbidity Combinations in Older Patients Undergoing Emergency General Surgery
复制标题
DOI：
10.1111/jgs.15682
复制
发表时间：
2019-03-01
影响因子：
6.3
通讯作者：
Koroukian, Siran M.
中科院分区：
文献类型：
--
作者：
Ho, Vanessa P.;Schiltz, Nicholas K.;Koroukian, Siran M.
在美国，每年有超过一百万的老年患者因急诊普通外科（EGS）条件而入院。主要有七种手术类型：结肠、小肠、胆囊、溃疡病、粘连松解术、阑尾和剖腹手术。已知较高的合并症负担会增加该人群的死亡率，但具体合并症组合的影响尚不清楚。我们的目的是（1）描述接受EGS的老年患者的手术分布、合并症和结局;以及（2）应用数据驱动的方法（关联规则挖掘）以确定与不成比例的高死亡率相关的合并症组合。设计、设置和参与者对65岁及以上的患者进行横断面研究，这些患者接受了先前引用的七种手术之一，从2011年全国住院病人样本中提取。结果：根据Elixhauser合并症指数，确定了280885例患者的住院死亡率、手术和合并症，总死亡率为5.6%。最常见的手术是胆囊切除术（33.7%）、溃疡手术（21.5%）和粘连松解术（21.0%）。随着患者年龄的增长，所有手术的死亡率均增加。与死亡率最高相关的合并症包括凝血功能障碍（校正比值比[aOR] = 3.74; 95%置信区间[CI] = 3.41-4.11; p <0.001），体液和电解质紊乱（FED）（aOR = 2.89; 95%CI = 3.66-3.14; p < .001）和肝脏疾病（aOR = 1.89; 95%CI = 1.61-2.22; p < .001）。与死亡率高度相关的三因素合并症为凝血功能障碍、FED和外周血管疾病（aOR = 5.10; 95%CI = 4.17-6.24; p < .001），凝血功能障碍、FED和慢性肺部疾病（aOR = 4.83; 95%CI = 4.00-5.82; p <0.001）.结论对于老年患者，合并症预示着比单一合并症更高的风险，相关的风险负担是由合并症的特殊组合决定的。未来的工作必须继续检查共病的影响，为接受EGS的老年患者提供个性化和现实的指导。J Am Geriatr Soc 67：503-510，2019.
BACKGROUND/OBJECTIVESOver a million older patients in the United States are admitted yearly for emergency general surgery (EGS) conditions. Seven procedure types dominate: colon, small bowel, gallbladder, ulcer disease, adhesiolysis, appendix, and laparotomy operations. A higher comorbidity burden is known to increase mortality in this population, but the impact of specific comorbidity combinations is unknown. Our objectives were to (1) characterize the distribution of procedures, comorbidities, and outcomes for older patients undergoing EGS; and (2) apply a data-driven approach (association rule mining) to identify comorbidity combinations associated with disproportionately high mortality.DESIGN, SETTING, AND PARTICIPANTSCross-sectional study of patients 65 years and older who underwent one of the seven procedures previously cited, taken from the 2011 Nationwide Inpatient Sample. A total of 280 885 patient encounters were identified.MEASUREMENTSIn-hospital mortality, procedures, and comorbidities based on the Elixhauser Comorbidity Index.RESULTSOverall mortality was 5.6%. The most common procedures were gallbladder (33.7%), ulcer surgery (21.5%), and adhesiolysis (21.0%). Mortality increased for all procedures as patients aged. Comorbidities associated with the highest mortality included coagulopathy (adjusted odds ratio [aOR] = 3.74; 95% confidence interval [CI] = 3.41-4.11; p < .001), fluid and electrolyte disorders (FED) (aOR = 2.89; 95% CI = 3.66-3.14; p < .001), and liver disease (aOR = 1.89; 95% CI = 1.61-2.22; p < .001). Three-way comorbidity combinations most highly associated with mortality were coagulopathy, FED, and peripheral vascular disease (aOR = 5.10; 95% CI = 4.17-6.24; p < .001), and coagulopathy, FED, and chronic pulmonary disease (aOR = 4.83; 95% CI = 4.00-5.82; p < .001).CONCLUSIONFor older patients, combinations of comorbidities portend additional risk beyond single comorbidities, and the associated risk burden is driven by the specific constellation of comorbidities present. Future work must continue to examine the effect of co-occurring diseases to provide personalized and realistic prognostication for older patients undergoing EGS. J Am Geriatr Soc 67:503-510, 2019.