老年患者胃肠道手术后综合并发症的危险因素——一项多中心观察性研究
吕雪彩, 刘艳红, 韩诗怡, 张浩赟, 侯爱生, 周志康, 史立凯, 高洁, 曹江北, 张宏, 米卫东

Risk factors for overall postoperative complications in elderly patients undergoing gastrointestinal surgeries: a multicenter observational study
Xuecai LÜ, Yanhong LIU, Shiyi HAN, Haoyun ZHANG, Aisheng HOU, Zhikang ZHOU, Likai SHI, Jie GAO, Jiangbei CAO, Hong ZHANG, Weidong MI
表1 患者的一般资料及单因素分析
Tab.1 Demographic characteristics and univariate analysis of the patients
ParameterTotal (n=1388)No postoperative complications (n=683)Have postoperative complications (n=705)OR (95% CI)P
Age (year)71.0 (68.0, 76.0)71.0 (68.0, 75.0)72.0 (68.0, 76.0)1.028 (1.008-1.048)0.005
Gender [n (%)]1.002 (0.804-1.250)0.984
Female906 (65.3%)446 (65.3%)460 (65.2%)
Male482 (34.7%)237 (34.7%)245 (34.8%)
Height (cm)164.6 (160.0, 170.0)165.0 (160.0, 170.0)164.6 (160.0, 170.0)1.001 (0.998-1.014)0.884
Weight (kg)63.7 (57.0, 70.0)63.7 (57.0, 70.0)63.7 (57.0, 70.0)0.997 (0.987-1.007)0.541
BMI (kg/m2)23.5 (21.3, 25.4)23.5 (21.3, 25.6)23.5 (21.4, 25.1)0.985 (0.953-1.018)0.374
ASA1.262 (1.001-1.590)0.049
Ⅰ-Ⅱ978 (70.5%)498 (72.9%)480 (68.1%)
Ⅲ-Ⅴ410 (29.5%)185 (27.1%)225 (31.9%)
Medical History [n (%)]
Hypertension605 (43.6%)289 (42.3%)316 (44.8%)1.107 (0.896-1.369)0.346
Diabetes290 (20.9%)131 (19.2%)159 (22.6%)1.227 (0.946-1.591)0.123
Coronary heart disease188 (13.5%)88 (12.9%)100 (14.2%)1.118 (0.821-1.521)0.479
Cerebrovascular disease79 (5.7%)31 (4.5%)48 (6.8%)1.537 (0.966-2.445)0.070
Respiratory disease55 (4.0%)21 (3.1%)34 (4.8%)1.597 (0.917-2.781)0.098
Kidney disease66 (4.8%)29 (4.2%)37 (5.2%)1.249 (0.759-2.055)0.381
Smoking432 (31.1%)218 (31.9%)214 (30.4%)0.930 (0.741-1.167)0.529
Alcohol consumption410 (29.5%)207 (30.3%)203 (28.8%)0.930 (0.738-1.171)0.537
Preoperative chronic pain255 (18.4%)106 (15.5%)149 (21.1%)1.459 (1.108-1.920)0.007
Preoperative nutritional support163 (11.7%)71 (10.4%)92 (13.0%)1.294 (0.931-1.798)0.125
Preoperative psychological and functional status
Frailty [n (%)]35 (2.5%)14 (2.0%)21 (3.0%)1.467 (0.740-2.909)0.272
EQ-5D1.0 (0.9, 1.0)1.0 (0.9, 1.0)0.9 (0.9, 1.0)0.073 (0.014-0.380)0.002
EQ-VAS76.0 (70.0, 80.0)76.0 (75.0, 80.0)76.0 (70.0, 80.0)0.992 (0.984-1.000)0.060
MET0.719 (0.483-1.070)0.104
<4108 (7.8%)45 (6.6%)63 (8.9%)
≥41280 (92.2%)638 (93.4%)642 (91.1%)
Preoperative laboratory test
PNI42.3 (37.4, 126.3)42.9 (38.1, 139.0)41.7 (36.8, 89.5)0.998 (0.997-1.000)0.043
Albumin (g/L)39.0 (36.2, 41.2)39.0 (36.5, 41.0)39.0 (36.0, 41.3)0.995 (0.984-1.006)0.401
Hemoglobin (g/L)120.6 (108.0, 134.0)122.0 (109.0, 135.0)120.3 (106.0, 134.0)0.996 (0.991-1.001)0.120
Glucose (µmol/L)5.5 (4.8, 5.8)5.5 (4.8, 5.8)5.5 (4.8, 5.8)1.021 (0.956-1.091)0.531
Intraoperative medication
Consumption of opioids (mg)143.5 (50.0, 232.9)140.0 (50.0, 230.0)148.0 (45.0, 240.0)1.000 (0.999-1.001)0.796
NSAIDs [n (%)]529 (38.1%)264 (38.7%)265 (37.6%)0.956 (0.770-1.187)0.683
Dexmedetomidine [n (%)]333 (24.0%)174 (25.5%)159 (22.6%)0.852 (0.666-1.090)0.203
Surgical/Anesthetic parameters
Blood loss (mL)100.0 (50.0, 128.7)60.0 (50.0, 128.7)100.0 (50.0, 128.7)1.002 (1.001-1.003)<0.001
Duration of surgery (min)191.5 (143.3, 240.0)185.0 (136.0, 230.0)198.4 (150.0, 250.0)1.002 (1.001-1.003)0.002
Location of surgery [n (%)]0.930 (0.746-1.160)0.521
Gastrectomy481 (34.7%)231 (33.8%)250 (35.5%)
Enterectomy907 (65.3%)452 (66.2%)455 (64.5%)
Type of surgery [n (%)]1.194 (0.934-1.527)0.157
Open1050 (75.6%)528 (77.3%)522 (74.0%)
Minimally invasive338 (24.4%)155 (22.7%)183 (26.0%)
Anesthesia methods [n (%)]0.843 (0.621-1.145)0.275
GA1197 (86.2%)582 (85.2%)615 (87.2%)
GA+RA191 (13.8%)101 (14.8%)90 (12.8%)
Postoperative analgesia methods [n (%)]0.191
No480 (34.6%)286 (36.5%)194 (34.6%)
Intravenous analgesia784 (56.5%)432 (55.2%)352 (56.5%)1.201 (0.954, 1.512)
Others124 (8.9%)65 (8.3%)59 (9.8%)1.338 (0.900, 1.990)
Postoperative acute pain1.359 (1.079-1.712)0.009
Mild to moderate pain973 (70.1%)501 (73.4%)472 (67.0%)
Severe pain415 (29.9%)182 (26.6%)233 (33.0%)