比较老年患者急诊和择期结肠切除术的结果:一项NSQIP研究。

IF 1.6 Q4 ONCOLOGY International Journal of Surgical Oncology Pub Date : 2021-12-06 eCollection Date: 2021-01-01 DOI:10.1155/2021/9990434
Mostapha El Edelbi, Ibrahim Abdallah, Rola F Jaafar, Hani Tamim, Samer Deeba, Samer Doughan
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引用次数: 3

摘要

导念:随着世界范围内结直肠癌(CRC)患病率的增加,特别是在老年人中,生理年龄和实足年龄之间的差异及其对功能状态的影响,急性症状导致结直肠癌恶性肿瘤紧急手术可能导致发病率和死亡率的增加。本研究的目的是确定80岁以上患者择期和紧急开放式结肠切除术的结果差异。方法:基于CPT编码对2010 - 2014年开放结肠切除术的国家外科质量改进计划(NSQIP)数据库进行检索。两组之间的比较是根据临床情况进行的,作为选择性或紧急手术。数据采用SAS分析。结果:8289例(70.8%)行选择性结肠切除术,3409例(29.1%)行紧急结肠切除术。急诊结肠切除术患者的美国麻醉医师协会(ASA)术前分类为III-IV,分别为1429(42.0%)和224(6.6%),而择期结肠切除术患者的分类为1238(14.9%)和21 (0.2%)(p < 0.0001)。急诊结肠切除术患者有更多的合并症,如慢性阻塞性肺疾病(493例(14.5%)比796例(9.6%))、充血性心力衰竭(206例(6.0%)比310例(3.8%))、透析(106例(3.1%)比56例(0.7%))和急性肾功能衰竭(166例(4.9%)比46例(0.6%))(p < 0.0001)。急诊结肠切除术的术后发病率和死亡率(1651(48.4%)和872(25.6%))明显高于择期结肠切除术(1859(22.4%)和567 (6.8%))(p < 0.0001)。结论:与择期开放式结肠切除术相比,老年患者急诊开放式结肠切除术的发病率和死亡率更高,危险因素为ASA分级更高,合并症更多。
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Comparing Emergent and Elective Colectomy Outcomes in Elderly Patients: A NSQIP Study.

Introduction: With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. The aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2010 to 2014 for open colectomy based on CPT codes. Comparison between groups was done based on the clinical context at presentation as elective or emergent surgery. Data were analyzed using SAS.

Results: Elective colectomies were performed in 8289 (70.8%) vs. emergent colectomies in 3409 (29.1%). Emergent colectomy patients had higher American Society of Anesthesiologists (ASA) preoperative classification III-IV, 1429 (42.0%) and 224 (6.6%), vs. 1238 (14.9%) and 21 (0.2%) in elective colectomy patients (p < 0.0001). Emergent colectomy patients had more comorbidities such as chronic obstructive pulmonary disorder (493 (14.5%) vs. 796 (9.6%)), congestive heart failure (206 (6.0%) vs. 310 (3.8%)), dialysis (106 (3.1%) vs. 56 (0.7%)), and acute renal failure (166 (4.9%) vs. 46 (0.6%)) (p < 0.0001), respectively. Postoperative morbidity and mortality were significantly higher in emergent colectomy (1651 (48.4%) and 872 (25.6%)) vs. elective colectomy (1859 (22.4%) and 567 (6.8%)) (p < 0.0001), respectively.

Conclusion: Emergent open colectomy in elderly patients carries a higher risk of morbidity and mortality when compared to elective open colectomy with risk factors being higher ASA classification and more comorbidities.

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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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