国家临床数据库和美国外科医师学会国家手术质量改进计划在主要胃肠外科手术中老年相关变量的国际比较

IF 3.3 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2025-04-21 DOI:10.1002/ags3.70021

Yasuhide Kofunato, Xane Peters, Arata Takahashi, Mark E. Cohen, Hiraku Kumamaru, Mitsukazu Gotoh, Yoshihiro Kakeji, Yasuyuki Seto, Yuko Kitagawa, Ken Shirabe, Hideki Ueno, Hiroaki Miyata, Clifford Y. Ko, Shigeru Marubashi

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引用次数: 0

摘要

背景：老年患者恶性疾病的发病率一直在上升。这些老年患者比年轻患者有更多的合并症和虚弱，需要不同的评估和治疗方法。日本的老年外科研究是继美国之后进行的。本研究的目的是比较两国接受胃肠外科手术患者的老年变量趋势，并阐明其特征。研究设计通过两国的全国数据库分析老年变量和结果。受试者定义为年龄≥65岁，因恶性疾病接受过7次大胃肠外科手术的患者。比较两组的基本统计值。结果共纳入美国国家临床数据库（NCD） 2703例患者和美国外科医师学会国家手术质量改进计划（NSQIP） 1342例患者。在术前合并症中，两个数据库中呼吸困难、高血压、出血性疾病和急诊病例均随年龄增长而增加，而NSQIP中肥胖和急诊病例的发生率更高。在两个数据库中，大多数术后并发症与年龄无关。在这两个国家，与老年相关的术前变量和结果因年龄而异。两个数据库的认知变量（痴呆史、代理签名同意书和谵妄）相似。然而，活动因素（使用活动辅助工具、跌倒史、高跌倒风险和新使用活动辅助工具）和术后功能依赖在NSQIP中比非传染性疾病更常见。结论：两国老年相关变量和结果随年龄变化相似，但活动能力和功能在两国之间存在差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

International Comparison of Geriatric-Associated Variables in Major Gastroenterological Surgery Between National Clinical Database and American College of Surgeons National Surgical Quality Improvement Program

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Backgrounds

Incidence of malignant disease in older patients has been increasing. These geriatric patients have more comorbidities and frailty than younger patients, necessitating different approaches in evaluation and treatment. Geriatric surgery studies in Japan have followed those conducted in the US. The aims of this study were to compare trends in geriatric variables for patients who underwent gastroenterological surgeries between two countries, and to elucidate the characteristics of them.

Study Design

Geriatric variables and outcomes were analyzed via nationwide databases in both countries. Subjects were defined as patients with age ≥ 65 who underwent seven major gastroenterological surgeries for malignant disease. Basic statistical values were compared between them.

Results

A total of 2703 patients in the National Clinical Database (NCD) and 1342 patients in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) were included. Among preoperative comorbidities, dyspnea, hypertension, bleeding disorder, and emergency cases increased with age in both databases, while the rates of obesity and emergency cases were more frequent in NSQIP. Most postoperative complications were not significantly associated with age in either database. Geriatric-associated preoperative variables and outcomes varied with age in both countries. Cognitive variables (history of dementia, surrogate-signed consent, and delirium) were similar between the two databases. However, mobility elements (use of mobility aid, fall history, high fall risk, and new use of mobility aid) and postoperative functional dependency were more frequent in NSQIP than NCD.