Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study.
Fiche publication
Date publication
août 2011
Auteurs
Membres identifiés du Cancéropôle Est :
Pr PESSAUX Patrick
Tous les auteurs :
Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D, Pessaux P, Hay JM
Lien Pubmed
Résumé
OBJECTIVE: To identify the mortality risk factors of elderly patients (>/=65 years old) during major digestive surgery, as defined according to the complexity of the operation. BACKGROUND: In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes. METHODS: We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality. RESULTS: In the entire cohort, postoperative mortality increased significantly among patients aged 65-74 years, and an age >/=65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36-3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age >/=85 years (OR, 2.62; 95% CI, 1.08-6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67-6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02-3.17; P = 0.041), white cell count > 10,000/mm(3) (OR, 1.90; 95% CI, 1.08-3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77-54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99-8.19; P < 0.001). CONCLUSION: Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients.
Référence
Ann Surg. 2011 Aug;254(2):375-82.