| ObjectivesBy studying the preoperative general conditions,complications,laboratory test indexes and the correlation between anesthesia and surgical events during operation and the occurrence of severe postoperative complications in the elderly patients undergoing elective surgery in orthopedics,gynecology and gastrointestinal surgery,the influencing factors of severe postoperative complications were discussed.MethodsFrom October 2017 to December 2021,the medical records of 332 hospitalized patients aged ≥80 who underwent orthopedic,gynecological and gastrointestinal surgery in the High-tech Hospital of the First Affiliated Hospital of Anhui Medical University were selected,and the Excel database was established.SPSS 25.0 was used for descriptive statistics,and the postoperative complications such as incision infection,lung infection,heart failure,myocardial infarction,acute kidney injury,cerebral infarction and delirium were analyzed by logistic regression.ResultsThe ratio of male to female patients in this group of elderly surgical patients is 0.59:1;There were 32 cases(10.7%)aged 80-89 years and 11 cases(33.3%)aged ≥90 years with severe postoperative complications.The occupancy rate of ICU was 49(17%),the average of total hospitalization days was 17.9 6.9 days,the median of postoperative hospitalization days was 10 days(7,15),and the median of total hospitalization expenses was 50,000 yuan(4.0,6.5).All patients underwent elective surgery,with ASA grade III in 10 cases(23.3%),IV in 32 cases(74.4%)and V in 1 case(2.3%).The anesthesia mode is a unified combined anesthesia of two or more methods.A total of43(13%)patients had serious complications after operation,including 6 cases of gynecological surgery(14.0%),21 cases of orthopedic surgery(48.8%)and 16 cases of gastrointestinal surgery(37.2%).Serious postoperative complications included heart failure in 12 cases(3.6%),myocardial infarction in 11 cases(3.3%),pulmonary infection in 10 cases(3%),acute kidney injury in 9 cases(2.7%),delirium in 8 cases(2.4%),incision infection in 7 cases(2.1%)and cerebral infarction in 6 cases(1.8%).Univariate analysis showed that there were significant differences between the two groups in age,BMI,ASA grade,modified Goldman grade,preoperative prealbumin,poorly controlled diabetes,heart disease,coronary heart disease,arrhythmia,pulmonary dysfunction,pleural effusion,hypoalbuminemia,pulmonary hypertension,operation start time,allogeneic blood transfusion rate and the lowest MAP during operation.Logistic regression analysis showed that BMI and the lowest MAP during operation decreased,ASA grade and improved Goldman grade increased,and the operation started late,which increased the risk of serious complications.Patients with poorly controlled diabetes mellitus have an increased risk of serious postoperative complications.Conclusion1.The severe postoperative complications of elderly patients are related to ASA grade,improved Goldman grade BMI,preoperative diabetes mellitus with poor control,intraoperative MAP and the time of operation.2.The early operation of elderly patients reduces the incidence of serious postoperative complications.It may be that the rhythm of a large amount of cortisol secretion caused by surgical trauma stress coincides with that of physiological cortisol secretion,which makes the stress tend to be beneficial to the body’s defense response and reduces the damage caused by excessive stress. |
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