Surgery in the Nineties
Surgery in the Nineties
复制标题
九十年代的外科手术
DOI：
10.1177/000313480006600902
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
David Mcfadden
中科院分区：
文献类型：
--
作者：
D. Rigberg;Michael Cole;Daryl Hiyama;David Mcfadden
美国人口正在老龄化，预计到2020年，16%的美国公民将超过65岁。关于九十多岁老人手术结果的报道很少，但据报道死亡率高达 45%。鉴于围手术期护理的最新进展，我们回顾了九岁老人的主要普通外科手术的经验。我们回顾了自 1986 年以来在加州大学洛杉矶分校医学中心接受普通外科手术的年龄大于或等于 90 岁的患者的图表。没有患者被排除在外。已确定 32 名患者。大多数（87.5%）患者有明显的病前状况。最常见的诊断是癌症（12 例）、嵌顿疝（7 例）、创伤（3 例）、结肠扭转（2 例）和胆囊炎（2 例）。围手术期总体死亡率为 9.4%（32 例中的 3 例）。 22 例手术（69%）是紧急进行的，所有 3 例死亡均属于该组（13.6%）。总体发病率为57%。平均住院时间为 4.8 天。大多数患者出院回家。我们的研究结果支持九岁老人择期普外科手术的围手术期安全性（死亡率为 0%，发病率为 20%）。我们还发现，尽管存在严重的合并症，但紧急手术的风险是可接受的（13.6% 的死亡率和 68% 的发病率）。大多数患者具有可接受的功能结果。
The population of the United States is aging, and by 2020 it is estimated that 16 per cent of U.S. citizens will be over 65 years of age. Little has been published about the results of surgery in nonagenarians but mortality rates of 45 per cent are reported. Given recent improvements in perioperative care we reviewed the experience with major general surgical operative procedures in nonagenarians. We reviewed the charts of patients greater than or equal to 90 years of age who underwent general surgical procedures at UCLA Medical Center since 1986. No patients were excluded. Thirty-two patients were identified. Most (87.5%) patients had significant premorbid conditions. The most common diagnoses were cancer (12), incarcerated hernia (seven), trauma (three), colonic volvulus (two), and cholecystitis (two). Overall perioperative mortality was 9.4 per cent (3 of 32). Twenty-two surgeries (69%) were performed on an emergency basis, and all three deaths were in this group (13.6%). Overall morbidity rate was 57 per cent. Mean intensive care unit stay was 4.8 days. Most patients were discharged home. Our findings support the perioperative safety of elective general surgery in nonagenarians (0% mortality and 20% morbidity). We also found an acceptable risk (13.6% mortality and 68% morbidity) for emergency procedures despite significant comorbid conditions. Most of the patients had acceptable functional outcomes.