紧急腹腔手术后老年患者的疗效--早期外科会诊至关重要

Surgeries Pub Date : 2024-03-23 DOI:10.3390/surgeries5020013
Rachel Gefen, Samer Abu Salem, A. Kedar, Joshua Zev Gottesman, G. Marom, A. Pikarsky, M. Bala
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引用次数: 0

摘要

我们的目的是研究老年患者急诊开腹手术(EL)后的死亡率与入院情况之间的关系,并假设最初入院的普外科患者的预后较好。一家三级医疗中心对三年内所有接受紧急开腹手术的老年患者(≥65 岁)的病历进行了回顾性分析。评估的结果包括术后发病率、死亡率、出院去向和再入院情况。共有 200 名患者符合研究条件,其中 106 人(53%)为男性,平均年龄为 77 ± 8.3 岁。死亡率为 29.5%(59 名患者),55% 的患者在入院后出院回家。肠梗阻是最常见的手术指征(91例,45.5%)。在非普通外科接受手术的患者再次入院率、出院不良率和死亡率较高,造口形成的发生率较高,需要气管造口术或依赖 TPN(所有 p < 0.001)。需要接受 EL 的老年患者最初通过非普外科服务入院时的死亡率较高。在治疗老年患者时,正确、快速的初步诊断和决定至关重要;最初入住普外科服务机构可增加出院回家的几率。
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Elderly Patients’ Outcomes following Emergency Laparotomy—Early Surgical Consultations Are Crucial
We aimed to study the relationship between mortality following emergency laparotomy (EL) in elderly patients and admission to a hospital facility, hypothesizing that patients initially admitted to a general surgery service have a better outcome. A retrospective review of the medical records of all the elderly patients (≥65 years) who underwent EL over three years was conducted in a single tertiary medical center. The outcomes evaluated include postoperative morbidity, mortality, discharge destination, and readmission. A total of 200 patients were eligible for this study; 106 (53%) were male, with a mean age of 77 ± 8.3 years. The mortality rate was 29.5% (59 patients), and 55% of all patients were discharged home after initial admission. Bowel obstruction was the most common indication for surgery (91, 45.5%). Patients undergoing an operation from non-general surgical services had higher readmission, unfavorable discharge and mortality rates, a greater incidence of stoma formation, and required a tracheostomy or were TPN-dependent (all p < 0.001). The mortality rate is higher in elderly patients needing an EL when initially admitted through a non-general surgery service. A correct and rapid initial diagnosis and decision are crucial when treating elderly individuals; initial admission to a general surgery service increases the probability of discharge home.
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