在非常老年人手术中需要更好的风险模型:评估85岁以上患者的ACS-NSQIP
Luz Divina Juez Sáez1, Carolina Hamdan Carnerero1, Eduardo Lisa2
1General and Digestive Surgery, Hospital Universitario Ramón y Cajal, España.
Revista espanola de enfermedades digestivas
|January 22, 2026
概括
美国外科医生学院国家外科质量改善计划 (ACS-NSQIP) 风险计算器准确预测了老年患者选择性胆囊切除术的结果. 然而,它低估了这一群体紧急手术的风险.
科学领域:
- 老年人手术是一门老年手术.
- 手术风险评估手术风险评估
- 胆病管理管理
背景情况:
- 胆囊切除术是症状胆结石的标准,但非常老年人的安全性是令人担忧的.
- 准确的风险预测对于老年患者的手术决策至关重要.
研究的目的:
- 评估美国外科医生学院国家外科质量改进计划 (ACS-NSQIP) 风险计算器在85岁及以上患者胆囊切除术预测结果的准确性.
- 评估ACS-NSQIP计算器在可选和紧急手术环境中的性能.
主要方法:
- 对接受胆囊切除术的≥85岁患者进行了回顾性队列研究.
- 收集了临床和外科变量;使用Clavien-Dindo.indo分类并发症.
- 应用了ACS-NSQIP风险计算器和评估的歧视 (AUC) 和校准 (布赖尔分数等). ) 的情况.
主要成果:
- 总体发病率为32.9%,死亡率为4.7%,在紧急手术 (60%发病率,15%死亡率) 和选择性手术 (24.6%发病率,1.5%死亡率) 中显著高.
- ACS-NSQIP对整体和严重并发症 (AUC 0.741和0.760) 的区别很好.
- 该模型充分预测了选择性手术的风险,但在紧急情况下严重低估了发病率和死亡率.
结论:
- ACS-NSQIP风险计算器适用于85岁以上患者的选择性胆囊切除术,但在紧急情况下低估了风险.
- 纳入脆弱性参数和老年评估可以改善这种高风险群体的风险预测和决策.
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