Stegge, W.B. aan de (2014) Complications in the elderly after oncological gastrointestinal surgery. thesis, Medicine.
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Abstract
Background: with the population ageing at an unprecedented rate, the number of surgical procedures in patients older than 65 years will in all likelihood increase. Despite improvement over the past decades adverse outcomes after gastrointestinal surgery in elderly patients are still high. Our primary objective is to determine the incidence of complications in patients undergoing oncological gastrointestinal surgery. Methods: all patients who had a resection of the stomach, jejunum/ileum, colon or rectum for gastrointestinal malignancies in our academical medical center from 2009 through 2012 were included (N = 508). Age cohorts were defined as < 65, 65 – 75 and ≥ 75 years. Complications were graded using the Clavien-Dindo Classification system, where grade I and II were addressed as minor and grade III, IV and V as major. All complications were addressed as surgical- or hospital-related. To identify differences in complications between age cohorts we analyzed the descriptive statistics for each age cohort. A multivariate regression analysis was used to identify risk factors for major complications in all three age cohorts. Results: The incidence of postoperative complications increased from 58.2% in patients < 65 years to 70.3% in patients ≥ 75 years (p < .025). The incidence of major complications remained the same in all age cohorts (p > .104). Hospital-related complications increased with age from 42.9% in patients < 65 to 59.2% in patients ≥ 75 years (p = .014), while there was no difference in surgical-related complications between age cohorts (p = .578). With advancing age fewer major complications are seen in complex procedures such as gastric resection and lower anterior resection. In less complex procedures such as right hemicolectomy and sigmoid resection more major complications are seen with advancing age. C-reactive protein (≥ 150 mg/l) (OR 3.409 (CI: 1.198 – 9.702)) and leucocyte count (≥ 15.0 109/l) (OR 5.924 (CI: 1.992 – 17.617)) were independent risk factors for major complications in the multivariate analysis for patients ≥ 75 years. Conclusion: in our study we found that the incidence of both, surgical-related complications and major complications, classified according to the Clavien-Dindo classification system, remained the same over all age cohorts. On the contrary, the incidence of hospital-related complications increased with advancing age. We feel that with early identification of postoperative complications due to monitoring the inflammatory response in the elderly we could improve postsurgical care and therefore may reduce the severity of postoperative complications and decrease in-hospital mortality.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Meerdink, N. M.D. and Pol, R.A. M.D. and Leeuwen, B.L. van M.D. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1159 |
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