高齢者，開腹手術の術後合併症に関する術前危険因子の検討

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タイトル別名
  • Prognostic Analysis for Postoperative Complications of Abdominal Surgery in the Elderly.
  • コウレイシャ カイフク シュジュツ ノ ジュツゴ ガッペイショウ ニ カンスル

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In order to evaluate the prognostic importance of the conditions before abdominal surgery for patients over 60 years of age. Multivariate analyses of postoperative complications were performed in 634 patients (comprising 525 cases of elective abdominal surgery and 109 cases of emergency abdominal surgery). The Mortality rate was significantly higher (p<0.01) in the emergency group (11.9%) and relatively low among the elective abdominal surgery group (3.8%). In the emergency group, 13 patients died, and MOF (multiple organ failure) was found to be the direct cause of death in 11 (85%). Although, the majority (75%) of emergency operations were for benign disorders, the remainder (25%) had malignant tumors. It is noteworthy that among 25% of cases, obstructions and perforations due to large bowel cancers were found to be 59% and 19%, respectively. In the elective surgery group, postoperative pulmonary and cardiovascular complications were found in 11.6% and 9.6%, respectively. Death due to cardiovascular problems in rare (5%), however, postoperative pneumonia was the cause of death in 70% of all of postoperative death. Risk factors affecting postoperative pulmonary complications were malnutrition, advanced age, male sex, malignant disease, dementia, cerebrovascular disorders, impaired pulmonary function tests. Surprisingly, the risk factors were identical, except for impaired pulmonary function, for postoperative MRSA pneumonia. In our study, postoperative pulmonary death was not associated with impaired pulmonary function, and it appears to be rather affected by the presence of cerebrovascular disorders and malnutritional state. A poor nutritional states (<40 according to Onodera's nutritional index) was present in over 50% of patients with cerbrovascular disorders and low ADL. In agreement with other reports, MRSA infections were frequently found in compromised hosts, and especially in the aged, in malnutritoned cases of gastrointestinal cancer. In summary, a malnutritional state is frequently associated with cerebrovascular disorders and low ADL is one of the major risk factors among patients who developed peneumonia after surgery. Further analysis is required to evaluate the preventive roles of nutritional management.

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