Priority areas for outcomes improvement among older adults undergoing inpatient general surgery inclusive of geriatric-pertinent complications.

IF 2.3 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2024-09-27 DOI:10.1002/wjs.12331

Hadiza S Kazaure, Kimberly S Johnson, Ronnie Rosenthal, Sandhya Lagoo-Deenadayalan

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引用次数: 0

Abstract

Background: Comprehensive studies on priority areas for improving geriatric surgery outcomes, inclusive of geriatric-pertinent data, are limited.

Methods: The ACS NSQIP geriatric database (2014-2018) was used to abstract older adults (≥65 years) undergoing inpatient general surgery procedures. Thirty-day complication, functional decline, and mortality rates were analyzed, with a focus on two geriatric-pertinent complications: delirium and new/worsening pressure ulcers.

Results: There were 9062 patients; 41.9% were ≥75 years. Mean age was 73.9 years. The majority of patients were female (54.0%), White (77.7%), and had independent functional status before surgery (94.0%). Overall 30-day complication, functional decline, and mortality rates were 33.6%, 34.5%, and 3.5%, respectively; failure to the rescue rate was 9.7%. Including geriatric-pertinent complications increased the overall complication rate by 20.4%. Delirium emerged as the leading complication (11.9%), followed by bleeding (11.1%), and wound-related complications (10.1%); these three accounted for 53.7% of complications. Delirium and pressure ulcers were associated with a >50% rate of postoperative functional decline (52.0% and 71.4%, respectively); pressure ulcers were also notable for a 25.5% failure to the rescue rate. Both were also among complications most likely to occur following the 3 most common procedures (colorectal surgery, pancreatic resections, and exploratory laparotomy), which overall accounted for approximately 79.6% of complications, 73.4% of patients experiencing functional decline, and 82.3% of mortality.

Conclusions: Delirium is the leading complication among older adults undergoing inpatient surgery. Overall, a small number of complications and procedure groups account for most surgical morbidity and mortality among older adults and thus constitute priority areas for outcomes improvement.

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在接受住院普通外科手术（包括老年病相关并发症）的老年人中，改善疗效的优先领域。

背景：有关改善老年外科手术结果的优先领域（包括老年病相关数据）的综合研究十分有限：方法：使用 ACS NSQIP 老年数据库（2014-2018 年）抽取接受住院普通外科手术的老年人（≥65 岁）。对30天并发症、功能衰退和死亡率进行分析，重点关注两种与老年病相关的并发症：谵妄和新发/恶化的压疮：共有 9062 名患者；41.9% 的患者年龄≥75 岁。平均年龄为 73.9 岁。大多数患者为女性（54.0%）、白人（77.7%），术前功能独立（94.0%）。30 天的总体并发症发生率、功能下降率和死亡率分别为 33.6%、34.5% 和 3.5%；抢救失败率为 9.7%。纳入老年病相关并发症后，总并发症发生率增加了 20.4%。谵妄是最主要的并发症（11.9%），其次是出血（11.1%）和伤口相关并发症（10.1%）；这三者占并发症的 53.7%。谵妄和压疮与术后功能衰退率超过 50% 相关（分别为 52.0% 和 71.4%）；压疮的抢救失败率也高达 25.5%。这两种并发症也是最常见的三种手术（结直肠手术、胰腺切除术和探查性开腹手术）后最容易出现的并发症，总计约占并发症的79.6%、功能衰退患者的73.4%和死亡率的82.3%：谵妄是老年人接受住院手术的主要并发症。总体而言，少数并发症和手术组别是老年人手术发病率和死亡率的主要原因，因此是改善手术效果的优先领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.