由于预计到2050年八十岁的人口将增加四倍,因此我们试图比较需要进行粘连性小肠梗阻(SBO)手术的八十岁患者的腹腔镜与开腹手术的结果。
使用2006-2015年美国外科医生学会国家外科质量改善项目,我们确定了年龄≥80岁的患者在入院后1天内接受了SBO急诊手术。感兴趣的风险变量包括年龄,性别,种族,身体质量指数,术前脓毒症,和美国麻醉医师协会(ASA)分类。结果包括逗留时间,死亡率,和肺炎。进行单变量和多变量分析。
确定了8156名患者。六百九十九(81.7%)进行了剖腹手术;157(18.3%)进行了腹腔镜检查。24例(15.3%)的腹腔镜病例被转换。开腹组和腹腔镜组在年龄上没有差异,和种族,术前白蛋白,或术前败血症。开放组完全依赖功能状态的比率更高,充血性心力衰竭,慢性阻塞性肺疾病,和更高的ASA类。手术时间没有差异。腹腔镜检查与住院时间较短有关。开放入路术后肺炎发生率较高,心肌梗塞,和死亡率。多变量分析显示年龄增加,功能状态,术前白蛋白,和ASA等级与死亡率相关。手术方法与死亡率无关。术后肺炎与男性和开放途径有关。
年龄,术前功能状态,术前白蛋白低,ASAIV级和V级与死亡率相关,而开放入路和男性与术后肺炎有关。由于粘连性疾病而出现SBO的八位老人可能会从最初的腹腔镜探索中受益。需要进一步的前瞻性研究。
With the population of octogenarians projected to increase fourfold by 2050, we sought to compare outcomes of laparoscopic versus open approach in octogenarians requiring surgery for adhesive small bowel obstruction (SBO).
Using 2006-2015 American College of Surgeons National Surgical Quality Improvement Project, we identified patients aged ≥80 y who underwent emergency surgery within 1 d of admission for SBO. Risk variables of interest included age, sex, race, body mass index, preoperative sepsis, and American Society of Anesthesiologists (ASA) classification. Outcomes included length of stay, mortality, and pneumonia. Univariable and multivariable analyses were performed.
Eight hundred fifty-six patients were identified. Six hundred ninety-nine (81.7%) underwent laparotomy; 157 (18.3%) underwent laparoscopy. Twenty-four (15.3%) of laparoscopic cases were converted. There was no difference between the open and laparoscopic groups in age, and race, preoperative albumin, or preoperative sepsis. The open group had higher rates of totally dependent functional status, congestive heart failure, chronic obstructive pulmonary disease, and higher ASA class. There was no difference in operative time. Laparoscopy was associated with shorter length of stay. The open approach showed higher rates of postoperative pneumonia, myocardial infarct, and mortality. Multivariable analysis showed increased age, functional status, preoperative albumin, and ASA class associated with mortality. The operative approach was not associated with mortality. Postoperative pneumonia was associated with male sex and open approach.
Age, preoperative functional status, low preoperative albumin, and ASA classes IV and V were associated with mortality, while the open approach and male sex were associated with postoperative pneumonia. Octogenarians who present with SBO due to adhesive disease may benefit from an initial laparoscopic exploration. Further prospective studies are warranted.