The significance of comorbidity burden among older patients undergoing abdominal emergency or elective surgery

Comorbidities may cause complications in perioperative care and affect treatment outcomes of older patients. The study aim was to analyse comorbidity burdens with respect to their predictive power in outcome prediction in elderly qualified for abdominal elective or emergency surgery. Consecutive patients undergoing major abdominal surgery between 2010 and 2017 at a secondary referral hospital were included in the retrospective study, for a total of 1586 patients. To explain the relationship between the comorbidity types and 30-day mortality and morbidity logistic regression analysis was performed. Morbidity was assessed using the Clavien-Dindo Score. Major complications were defined as a C-D score ≥ 3. We also presented the data concerning need for reoperation and ICU admission. 85.9% of patients had at least one comorbidity. In the group of emergency patients age and number of comorbidities were independent risk factors of 30-day mortality and major morbidity. In elective patients age, dementia (OR:3.52; 95%CI:1.35–9.20) and kidney disease (OR:1.64; 95%CI:1.04–2.57) were found to be independent risk factors of 30-day postoperative mortality. Age (1.04; 95%CI:1.00–1.08) and heart disease (OR:1.30, 95%CI:1.04–1.63) were found to be independent risk factors of 30-day major morbidity. In patients undergoing elective surgery 30-day mortality and morbidity was associated with age. 30-day mortality, but not morbidity was associated with kidney disease and dementia. 30-day morbidity, but not mortality, was associated with heart disease.

合并症可在围手术期护理中引发并发症，进而影响老年患者的治疗结局。本研究旨在分析合并症负荷对符合腹部择期或急诊手术指征的老年患者术后结局的预测能力。本回顾性研究纳入2010年至2017年间，于某二级转诊医院接受大型腹部手术的连续患者，共计1586例。为阐明合并症类型与术后30天死亡率及并发症发生率之间的关联，本研究采用逻辑回归分析方法。采用Clavien-Dindo评分（Clavien-Dindo Score）评估术后并发症发生率，将C-D评分≥3分定义为严重并发症。本研究同时披露了需再次手术及入住重症监护室（ICU，Intensive Care Unit）的相关数据。85.9%的患者存在至少1种合并症。在急诊手术患者组中，年龄与合并症数量是术后30天死亡率及严重并发症发生率的独立危险因素。在择期手术患者组中，年龄、痴呆症（比值比OR:3.52；95%置信区间CI:1.35–9.20）与肾脏疾病（比值比OR:1.64；95%置信区间CI:1.04–2.57）被确定为术后30天死亡率的独立危险因素。年龄（1.04；95%置信区间CI:1.00–1.08）与心脏疾病（比值比OR:1.30，95%置信区间CI:1.04–1.63）被确定为术后30天严重并发症发生率的独立危险因素。在择期手术患者中，术后30天死亡率与并发症发生率均与年龄相关；术后30天死亡率（而非并发症发生率）与肾脏疾病及痴呆症相关；术后30天并发症发生率（而非死亡率）与心脏疾病相关。