老年病人胰十二指肠切除术后严重并发症发生的危险因素

Risk factors of severe postoperative complications in elderly patients with pancreaticoduodenectomy

目的:研究老年病人胰十二指肠切除术(pancreaticoduodenectomy, PD)术后严重并发症发生的危险因素。方法:回顾性分析2016年1月至2020年12月本院行PD 399例≥65岁(65~91岁)老年病人的临床资料,其中≥75岁76例(19.0%)。Barthel指数低提示生活自理能力低下。用二元Logistic回归分析PD术后严重并发症的危险因素,构建预测模型。以受试者工作特征(ROC)曲线验证模型的预测效能。结果:399例老年PD病人中,术后并发症发生224例,总发生率56.14%。轻度并发症187例(46.87%),严重并发症37例(9.27%)。年龄≥75岁(OR=2.78, P<0.05)、合并高血压(OR=4.20, P<0.05)和Barthel指数(提示生活自理能力)低(OR=0.96, P<0.05)为老年PD术后严重并发症发生的独立危险因素。以年龄、合并高血压、术前营养风险、手术形式、生活自理能力的Barthel指数、手术时间6项指标构建PD术后严重并发症的风险模型,回归方程拟合度0.93。ROC曲线显示,该模型曲线下面积AUC为0.76,灵敏度65%,特异度76%。结论:年龄≥75岁、合并高血压且生活自理能力低为老年病人PD术后严重并发症的独立性危险因素。以年龄等6项指标构建的模型能较好预测老年病人PD术后严重并发症的发生。

Objective To investigate the risk factors of severe complications of elderly patients with pancreaticoduo-denectomy(PD).Methods The clinical data of 399 elderly patients with PD and 65 years or more(65-91years)including 76 cases with 75 years or more(19.0%)in this hospital from January 2016 to December 2020,were retrospectively ana-lyzed.Less Barthel index score was used to indicate lower activities of daily living.The risk factors of severe complications after PD were analyzed by binary Logistic regression and predictive model was established.Receiver operating characteris-tic(ROC)curve was used to verify the predictive efficiency of model.Results A total of 224 cases were found postoperative complications from 399 elderly PD cases with the rate 56.14%including 187(46.87%)cases of mild complications and 37(9.27%)cases of severe complications.Age≥75 years(OR=2.78,P<0.05),combined with hypertension(OR=4.20,P<0.05)and less Barthel index score(OR=0.96,P<0.05)were independent risk factors for severe complications after PD in elderly patients.The risk prediction model of severe postoperative complications of PD was constructed using 6 indexes including age,hypertension,preoperative nutritional risk,operative type,Barthel index score in activities of daily living and operative time,and the fit of regression equation 0.93.ROC curve analysis showed that area under curve(AUC)was 0.76,the sensiti-vity 65%,and the specificity 76%.Conclusions Age 75 years or more,hypertension and low activities of daily living would be independent risk factors for severe complications after PD in elderly patients.The risk model constructed by age,hyper-tension,preoperative nutritional risk,operative type,Barthel index score in activities of daily living and operative time had certain predictive efficacy for severe complications after PD in elderly patients.