Priority areas for outcomes improvement among older adults undergoing inpatient general surgery inclusive of geriatric-pertinent complications.

Autor: Kazaure HS; Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina, USA., Johnson KS; Durham VA Health Care System, Geriatric Research and Clinical Center, Durham, North Carolina, USA.; Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Center for Palliative Care, Duke University School of Medicine, Durham, North Carolina, USA., Rosenthal R; Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA., Lagoo-Deenadayalan S; Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina, USA.; Durham VA Health Care System, Geriatric Research and Clinical Center, Durham, North Carolina, USA.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2024 Nov; Vol. 48 (11), pp. 2646-2657. Date of Electronic Publication: 2024 Sep 27.
DOI: 10.1002/wjs.12331
Abstrakt: Background: Comprehensive studies on priority areas for improving geriatric surgery outcomes, inclusive of geriatric-pertinent data, are limited.
Methods: The ACS NSQIP geriatric database (2014-2018) was used to abstract older adults (≥65 years) undergoing inpatient general surgery procedures. Thirty-day complication, functional decline, and mortality rates were analyzed, with a focus on two geriatric-pertinent complications: delirium and new/worsening pressure ulcers.
Results: There were 9062 patients; 41.9% were ≥75 years. Mean age was 73.9 years. The majority of patients were female (54.0%), White (77.7%), and had independent functional status before surgery (94.0%). Overall 30-day complication, functional decline, and mortality rates were 33.6%, 34.5%, and 3.5%, respectively; failure to the rescue rate was 9.7%. Including geriatric-pertinent complications increased the overall complication rate by 20.4%. Delirium emerged as the leading complication (11.9%), followed by bleeding (11.1%), and wound-related complications (10.1%); these three accounted for 53.7% of complications. Delirium and pressure ulcers were associated with a >50% rate of postoperative functional decline (52.0% and 71.4%, respectively); pressure ulcers were also notable for a 25.5% failure to the rescue rate. Both were also among complications most likely to occur following the 3 most common procedures (colorectal surgery, pancreatic resections, and exploratory laparotomy), which overall accounted for approximately 79.6% of complications, 73.4% of patients experiencing functional decline, and 82.3% of mortality.
Conclusions: Delirium is the leading complication among older adults undergoing inpatient surgery. Overall, a small number of complications and procedure groups account for most surgical morbidity and mortality among older adults and thus constitute priority areas for outcomes improvement.
(© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Databáze: MEDLINE
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