非老年人与八十岁患者的手术结果:一种倾向匹配的分析,对共享决策产生影响
Fahim Kanani1, Eduard Khabarov2, Andrey Chopen2
1From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Kanani, Khabarov, Chopen, Messer, Zoabi, Zahalka, Shimonov, Dayan, Kamar); the Department of Surgery, Wolfson Medical Center, Holon (Kanani, Zahalka, Shimonov, Dayan, Kamar); the Emergency Department, Wolfson Medical Center, Holon (Kanani, Khabarov, Chopen, Kamar); the Tel Aviv Sourasky Medical Center, Tel Aviv (Kanani, Messer); the Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel (Zoabi) faheemk@wmc.gov.il.
一般外科手术的结果是显着更糟糕的nonagenarians比八十岁的,与更高的死亡率和功能下降. 由于这些风险,非操作管理应该被认为是非老年人的默认管理.
科学领域:
- 老年人手术是一门老年手术.
- 手术结果研究研究
- 老年人患者的患者安全
背景情况:
- 关于非老年患者 (90岁以上) 手术结果的证据有限.
- 八旬期 (80-89岁) 的手术结果得到了更好的记录.
- 对比这些极端年龄组对于临床决策至关重要.
研究的目的:
- 为了比较30天,90天和1年的死亡率,在nonagenarian和八十岁的普通手术患者之间.
- 评估功能状态,并发症和再录取的差异.
- 确定影响老年人手术结果的因素.
主要方法:
- 回顾性队列研究 (2013-2023) 与 1:1 倾向性得分匹配.
- 包括80至99岁的接受全科手术的患者.
- 主要结局:30天全因死亡率;次要结局:长期死亡率,功能状态,并发症,再入院.
主要成果:
- 非老年人表现出明显更高的30天 (26.0%对9.6%),90天 (49.3%对23.3%) 和1年 (75.3%对39.7%) 的死亡率.
- 非老年人功能状况更差,30天再入院率更高 (42.5%与21.9%相比).
- 尽管匹配,但仍然存在显著的脆弱性失衡,这表明外科手术非老年人的内在选择偏差.
结论:
- 非老年患者经历的外科手术结果比八十岁患者要糟糕得多.
- 高死亡率和功能障碍表明非手术管理作为非老年人的默认.
- 对非老年人的手术应该在经过全面的老年评估和共享决策后,保留给精选的病例.
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