背景:越来越多的老年患者需要紧急腹部手术治疗急腹症。他们容易受到手术压力,并在日常活动中失去独立性。腹腔镜手术与更快的恢复有关,术后疼痛减少,缩短住院时间。然而,很少有研究研究腹腔镜手术与身体功能下降之间的关系。因此,我们旨在研究身体功能变化与外科手术之间的关系。
方法:在这是一个单中心,回顾性队列研究,我们纳入了年龄≥65岁,在2019年1月1日至2021年12月31日期间因急腹症行紧急腹部手术的患者.我们使用Barthel指数评估了他们的日常生活活动。功能下降定义为术后28天Barthel指数下降≥20点,与术前比较值。我们评估了老年患者的功能下降与外科手术之间的关系,采用多元Logistic回归分析。
结果:在研究期间,852例患者行急诊腹部手术。其中,280名患者符合分析条件。其中,94人接受了腹腔镜手术,186人接受了开放手术。接受腹腔镜手术的患者在术后28天显示功能下降较少(6vs.49,p<0.001)。在调整其他协变量后,腹腔镜手术是术后功能下降的独立预防因素(OR,0.22;95%CI,0.05-0.83;p<0.05)。
结论:在紧急腹部手术中,腹腔镜手术减少了老年患者术后身体功能下降。广泛使用腹腔镜手术可以潜在地保持患者的生活质量,并且对于更好地开展紧急腹部手术可能很重要。
BACKGROUND: An increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure.
METHODS: In this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis.
RESULTS: During the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p < 0.001). After adjustments for other covariates, laparoscopic surgery was an independent preventive factor for postoperative functional decline (OR, 0.22; 95% CI, 0.05-0.83; p < 0.05).
CONCLUSIONS: In emergency abdominal surgery, laparoscopic surgery reduces postoperative physical functional decline in older patients. Widespread use of laparoscopic surgery can potentially preserve patient quality of life and may be important for the better development of emergency abdominal surgery.