Effect of Age Alone on Major Complications After Gastrointestinal Surgery
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RESEARCH COMMUNICATION
Effect of Age Alone on Major Complications After Gastrointestinal Surgery Yuhi Lee 1 & Ryusuke Ueki 1 & Munetaka Hirose 1 Received: 15 September 2020 / Accepted: 1 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Aging . Perioperative managements . Postoperative complications
Introduction Major complications after surgery, defined as Clavien-Dindo class IIIa and greater, seriously affect patient outcomes. Although old age is reportedly one of the risk factors for major complications after gastrointestinal surgery 1,2, several investigators reported that age was not found to be the risk factor of major complications after gastrointestinal surgery 3,4. These discrepancies in the effects of aging on major complications have been thought to be caused by the aging process including either the effects of age alone or several conditions and comorbidities. The effects of age alone on major complications after gastrointestinal surgery, however, have not been evaluated well. In the present study, we investigated associations between age alone and major complications after gastrointestinal surgery.
Methods This single-institution prospective observational study was approved by the Ethics Committee of Hyogo College of Medicine (Ethical Committee number 3138). The informed consent was obtained using an opt-out form on our institutional web-site. Consecutive adult patients undergoing gastrointestinal surgery under general anesthesia from March 2019 to February 2020 at our institutional surgical center were
* Munetaka Hirose [email protected] 1
Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
enrolled in this study. Inclusion criteria was patients aged 20 years and above. Postoperative complications within 30 days after surgery were graded according to the extended Clavien-Dindo classification. Major complications were defined as Clavien-Dindo grade IIIa or greater. Surgical severity, which was estimated according to type of surgery, was divided into the three categories of low, intermediate, and high procedure risk 5. After receiver-operating characteristic curve analysis between age and major complications revealed that a cut-off value of age for major complications was 74 years (sensitivity/specificity = 0.381/0.729, p < 0.01), comparisons of perioperative variables between patients aged < 75 years (nonelderly group) and ≥ 75 years (elderly group) was performed using the chi-square test or the Mann-Whitney Wilcoxon test as a post hoc test after the Kruskal-Wallis test for appropriate variables. The statistically significant level was considered as p < 0.05. To exclude confounding factors for aging process, logistic regression analysis was performed to identify risk factors for major complication.
Results There was a significant difference in the incidence of major complications: 13.1% in the non-elderly group (n = 518) and 19.6% in the elderly group (n = 189) (Table 1). Independent varia
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