Risk Factors Of Elderly Patients' Outcome Undergoing Gastrointestinal Surgery

Objective : To explore the risk factors of elderly patients' outcome undergoing gastrointestinal surgery.Methods: We retrospectively reviewed the perioperative clinical data of elderly patients(>=75 years)underwent gastrointestinal surgery in Ruijin hospital from January 2016 to January 2017.The clinical data included surgical conditions,Anesthesia medication,the occurrence of adverse events perioperatively,postoperative hospitalization,30-day hospital re-admission rate after discharge and postoperative hospital mortality.All these possible factors were analyzed through monofactor and multifactor regression in order to screening the relevant risk factors affecting the perioperative outcome of elderly patients.Results: Perioperative adverse events(during hospitalization)occurred in 71 of the 242 patients(71/242,29.34%)aged 75 y or older,8 patients were hospitalized again after discharge,and 3 patients had hospitalized deaths.Monofactor analysis indicated that conventional laparotomy(P=0.001),high ASA grade(P=0.025),high NYHA grade(P=0.000),poor Barthel index(P=0.001),history of chronic renal insufficiency(P=0.013),abnormal chest imaging examination preoperatively(P=0.008),long operation time(P=0.030),preoperative high level of blood urea nitrogen(P=0.049)and longer APTT(P=0.019)were the risk factors that would increase the incidence rate of perioperative adverse events.Logistic regress analysis indicated that the type of surgery(OR=0.348),NYHA grade(OR=1.985)and Barthel index(OR=9.364)were the relevant factors influencing the occurrence of adverse events perioperatively.Linear regression analysis showed that the type of surgery(Correlation coefficient:-5.052),duration of operation(Correlation coefficient: 0.038),Barthel index(Correlation coefficient: 6.424),NHYA grade(Correlation coefficient: 2.054)were the relevant factors influencing the postoperative hospital stay.Conclusions: We summarized that conventional laparotomy,poor ASA grade,NYHA classification and Barthel index classification,combined with chronic renal insufficiency,abnormal chest imaging examination,long operation time,high level of blood urea nitrogen and long APTT are the risk factors that could increase the incidence rate of perioperative adverse events.And the surgical approach,NYHA classification and Barthel index classification have important significance.Conventional open surgical approach,long operation time,poor Barthel index and NYHA grade will prolong the postoperative hospitalization.