Risk Factors for Mortality in Major Digestive Surgery in the Elderly A Multicenter Prospective Study
Risk Factors for Mortality in Major Digestive Surgery in the Elderly A Multicenter Prospective Study
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DOI：
10.1097/sla.0b013e318226a959
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发表时间：
2011-08-01
影响因子：
9
通讯作者：
Hay, Jean-Marie
中科院分区：
文献类型：
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作者：
Duron, Jean-Jacques;Duron, Emmanuelle;Hay, Jean-Marie
目的：根据消化外科手术的复杂性，探讨老年患者(<65岁)在重大消化外科手术中的死亡危险因素。背景：在发达国家老龄化人口中，大型消化外科手术的发病率呈上升趋势，且死亡率较高。因此，必须开发有效的指标来改善老年患者的手术护理和结果。方法：我们从一项多中心前瞻性队列中获得数据，该队列包括47个不同机构的3322名连续接受大型消化手术的患者。我们评估了27个术前、术中和术后的人口统计学和临床变量。采用多因素分析确定老年患者死亡的独立危险因素(n=1796)。结果：在整个队列中，65-74岁的患者术后死亡率显著增加，年龄<65岁是死亡的独立危险因素(优势比[OR]，2.21；95%可信区间[CI]，1.36-3.59；P=0.001)。老年患者死亡率为10.6%。年龄=85岁(OR2.62；95%CI1.08~6.31；P=0.032)、急诊(OR3.42；95%CI1.67~6.99；P=0.001)、贫血(OR1.8；95%CI1.02~3.17；P=0.041)、白细胞计数、10,000/mm(3)(OR1.9；95%CI1.08~3.35；P=0.024)，ASAIV级(OR9.86；95%CI1.77-54.7；P=0.009)和姑息性癌症手术(OR4.03；95%CI1.99-8.19；P<；0.001)。结论：确定独立的有效风险指标是老年大消化手术患者死亡率的基本特征，并可能导致有效的具体检查，这是为老年患者制定专门评分的必要步骤。
Objective: To identify the mortality risk factors of elderly patients (>= 65 years old) during major digestive surgery, as defined according to the complexity of the operationBackground: In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes.Methods: We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality.Results: In the entire cohort, postoperative mortality increased significantly among patients aged 65-74 years, and an age >= 65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36-3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age >= 85 years (OR, 2.62; 95% CI, 1.08-6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67-6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02-3.17; P = 0.041), white cell count > 10,000/mm(3) (OR, 1.90; 95% CI, 1.08-3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77-54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99-8.19; P < 0.001).Conclusion: Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients.