老年患者胃肠肿瘤根治手术术前衰弱与术后并发症的相关性

Association between preoperative frailty and postoperative complications in elderly patients undergoing radical surgery of gastrointestinal tumor

目的探讨老年患者胃肠肿瘤根治手术术前衰弱与术后并发症的相关性。方法回顾性分析2018年9月至2021年1月择期全麻下行胃肠肿瘤根治手术的老年患者567例,男416例,女151例,年龄≥65岁,ASAⅠ—Ⅴ级。收集患者临床资料及相关临床指标等围术期资料,采用改良衰弱指数(mFI)评估患者术前衰弱状态。根据术后30 d是否发生并发症将患者分为三组:无并发症组,一般并发症组和严重并发症组。收集并记录年龄、ASA分级等围术期相关临床资料。采用Logistic回归分析术后并发症的危险因素。结果术后30 d内共有276例(48.7%)患者发生一般并发症,51例(9.0%)患者发生严重并发症。单因素分析显示,与无并发症组比较,一般并发症组和严重并发症组年龄明显增大,ASAⅢ或Ⅳ级比例、衰弱比例明显升高(P<0.05)。Logistic回归分析结果显示术前衰弱是术后30 d内严重并发症的独立危险因素(OR=3.545,95%CI 1.294~9.711,P=0.014)。结论术前衰弱是老年患者胃肠肿瘤根治手术术后30 d内发生严重并发症的独立危险因素。

Objective To explore the association between preoperative frailty with postoperative complications in elderly patients undergoing radical surgery of gastrointestinal tumor. Methods From September 2018 to January 2021, 567 patients, underwent radical gastrointestinal tumor resection under general anesthesia. 416 males and 151 females aged ≥ 65 years, ASA physical status Ⅰ to Ⅴ,were selected. Perioperative data including clinical data and related clinical indicators were collected. Preoperative frailty status of patients was assessed by the modified Frailty Index(mFI). According to the state of postoperative complications, patients were divided into three groups: non-complication group, minor complication group and major complication group. Peri operative clinical data such as age and ASA physical status were collected and recorded. Logistic regression analysis were used to analyze the influencing factors of different degrees of postoperative complications. Results Minor complication occurred in 276(48.7%)patients and major complication occurred in 51(9.0%)patients within 30 days after surgery. Compared with the non-complication group, the age of minor complication group and major complication group was significantly increased, and the proportion of ASA physical status Ⅲ or Ⅳ and frailty was significantly increased(P < 0.05). Logistic regression analysis showed that preoperative frailty was an independent risk factor for postoperative major complication(OR = 3.545, 95% CI 1.294-9.711, P = 0.014). Conclusion Preoperative frailty was an independent risk factor for major complication within 30 days after radical surgery of gastrointestinal tumors in elderly patients.