衰弱与老年人腹腔镜术后快速康复相关性探讨

摘要

目的 评价术前老年综合评估,特别是衰弱对老年患者腹腔镜手术术后快速康复以及不良事件的预测能力. 方法 前瞻性观察2015年6月到2015年10月75例年龄大于70岁行腹腔镜择期手术的老年患者,术前进行老年综合评估,观察终点为术后住院时间、住院期间全因病死率、术后并发症. 结果 术后平均住院时间为(9.7 ± 7.3)d,单因素结果显示衰弱(P=0.015),共病(P=0.004)与老年人术后住院时间显著相关.多元Logistic回归分析显示衰弱(OR=5.26,95%CI:1.22~22.55,P=0.025),多病共存(OR=5.12,95% CI:1.63~15.99,P=0.005)为住院时间延长的危险因素.共有17位受试者(22.7%)存在至少1个并发症,单因素分析发现并发症与衰弱(P=0.007)、营养不良风险(P=0.012)和共病(P=0.005)显著相关.多元Logistic回归分析显示衰弱(OR=6.03,95% CI:1.39~26.10,P=0.016),营养不良风险(OR=4.30,95% CI:1.03~17.86,P=0.045),多病共存(OR=5.41,95% CI:1.47~19.83,P=0.011)的老年人术后并发症风险增加. 结论 在老年人腹腔镜手术中,衰弱状态不利于老年人快速康复,老年综合评估有助于识别出术后并发症及住院时间增加的高危险老年患者,手术医生可根据老年人整体状态制定出有针对性的预防和干预措施,以改善手术预后.%Objective To explore the predictive value of pre-operative comprehensive geriatric assessment(CGA),especially regarding frailty,on the outcomes of fast-track surgery and the risk of post-operative complications after elective laparoscopic surgery in geriatric patients. Methods This prospective study included 75 patients aged 70 years and above undergoing elective laparoscopic surgery from June 2015 to October 2015.CGA was conducted with length of postoperative hospitalization,all-cause mortality and postoperative complications as the endpoints. Results The mean length of hospital stay after surgery was 9.7 day(9.7 ± 7.3)and was correlated with frailty scores(P=0.015)and comorbidities(P= 0.004).Multivariate Logistic regression analysis showed that frailty(OR=5.26,95% CI:1.22-22.55,P=0.025)and comorbidity(OR=5.12,95% CI:1.63-15.99,P=0.005)were predictors of prolonged hospitalization after surgery.Seventeen of 75 patients (22.7%)experienced at least one adverse postoperative outcome,and bivariate analysis showed that adverse events were correlated with poor nutrition(P= 0.012),high frailty scores(P=0.007),and multiple comorbidities(P= 0.005).Furthermore,multiple regression analysis identified malnutrition (OR= 4.30,95% CI:1.03-17.86,P= 0.045),comorbidity(OR= 5.41,95% CI:1.47-19.83,P=0.011)and frailty(OR=6.03,95% CI:1.39-26.10,P=0.016)as predictors of adverse postoperative outcomes. Conclusions Frailty is a risk factor for elderly patients undergone fast-track laparoscopic surgery,and preoperative CGA scores may be used to identify high-risk patients for adverse surgical outcomes and prolonged hospital stay.