The influence of age on clinical and patient-reported outcomes after cholecystectomy |
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Authors: | Dr Elizabeth A Mort MD MPH Edward Guadacnoli PhD Steven A Schroeder MD Sheldon Greenfield MD Albert G Mulley MD MPP Barbara J McNeil MD PhD Paul D Cleary PhD |
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Institution: | (1) the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts;(2) the Center for Cost Effective Care, Brigham and Women’s Hospital, Boston, Massachusetts;(3) the Institute for the Improvement of Medical Care and Health, New England Medical Center, Boston, Massachusetts;(4) the General Internal Medicine Unit, Medical Services, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts;(5) the University of California, San Francisco;(6) Present address: the Robert Wood Johnson Foundation, Princeton, New Jersey;(7) Medical Practices Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, 02114 Boston, MA |
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Abstract: | Objective: To examine the relationship between the age of cholecystectomy patients and surgical complications, length of stay, symptom
relief, and postdischarge functional status.
Design: Patients’ medical records were reviewed and patients were sent a questionnaire three months after hospital discharge.
Setting: Four university-affiliated teaching hospitals.
Patients: 372 patients who had a primary operation of total cholecystectomy.
Outcome measures: In-hospital complications, length of stay, patient satisfaction, symptom relief, and functional status after discharge.
Results: Patients over the age of 60 years experienced a higher major postoperative complication rate than did younger patients (p<0.01),
although the overall major complication rate was too low to determine whether factors other than age were important predictors.
There was no age-related difference in minor postoperative complication rates. The older patients had a longer mean length
of stay, even after statistical adjustment for covariates (p<0.05). The older patients reported similar levels of patient
satisfaction, but reported recurrence of pre-operative abdominal pain less often than did the younger patients (OR=0.4, 95%
CI=0.2, 0.7). There was no statistically significant difference between the older and younger patients in postoperative functioning,
except for work performance. The younger patients reported improvement in postoperative work performance, while the older
patients reported a decline (p < 0.01).
Conclusions: Older cholecystectomy patients may experience more postoperative complications but report less recurrence of preoperative
abdominal pain than do younger patients. The decline in work performance in older patients may indicate the need for a longer
recuperation period.
Supported in part by grants from the National Institute on Aging (AGO833101), the Robert Wood Johnson Foundation, and the
John A. Hartford Foundation. |
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Keywords: | cholecystectomy age factors outcomes functional status quality of life |
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