Key points of anesthesia management and influencing factors of postoperative complications in elderly patients with retroperitoneal tumors

doi:10.3877/cma.j.issn.1674-0785.2024.10.001

Abstract

Abstract:

Objective

To summarize and analyze the key points of anesthesia management for elderly patients undergoing retroperitoneal tumor resection and its impact on patient prognosis, with an aim to provide reference for perioperative management of such patients.

Methods

This study retrospectively analyzed the anesthesia management of elderly patients (aged≥65 years) who underwent retroperitoneal tumor resection under general anesthesia at Peking University International Hospital from January 2015 to December 2022, and identified the influencing factors of total length of stay, postoperative hospitalization duration, and postoperative complication classification.

Results

A total of 248 patients were included in this study, including 136 males and 112 females with an average age of (69.7±4.4) years.Preoperative ASA classification was 134 cases of grade II, 106 cases of grade III, and 8 cases of grade IV.One hundred and twenty-nine patients (52.0%) had two or more surgeries, with the duration of surgery and anesthesia being(287.2±132.0) minutes and (362.9±135.9) minutes, respectively.Goal-directed fluid therapy was used during surgery, and blood products were supplemented according to the indications for blood transfusion.After surgery, 198 patients (79.8%) were extubated and returned to ordinary ward, while 50 patients (20.2%)were admitted to the intensive care unit for further treatment.The mean total length of stay was (38.0±21.9)days, and the mean length of postoperative hospitalization was (26.5±20.7) days.Multiple linear regression analysis showed that the length of hospitalization and postoperative hospitalization were positively correlated with the use of prothrombin complex concentrate during surgery and the level of blood glucose at the end of surgery.There were 44 cases of severe complications (Clavien-Dindo grade≥3a) after surgery, Logistic regression analysis showed that male gender, intraoperative infusion of artificial colloid solution, and postoperative lactate level were independent risk factors for severe postoperative complications; Four deaths occurred due to septic shock, hemorrhagic shock, and multiple organ failure.

Conclusion

For elderly patients undergoing retroperitoneal tumor resection, comprehensive preoperative preparation and more precise anesthesia management are required.During the operation, surgeons should avoid the infusion of artificial colloidal fluids, carefully administer prothrombin complex concentrate, and monitor male patients, blood glucose, and lactate levels after surgery.Targeted treatment can help improve patient prognosis.

Key words: Elderly, Retroperitoneal tumor, Anesthesia management, Postoperative complications

Jungang1 Cai, Kunpeng Liu, Lan Yao, Hua Zhang, Libin Suo, Jun Wang, Hongpei Li, Yue Wei, chengli Miao, Jun Chen, Chenghua Luo. Key points of anesthesia management and influencing factors of postoperative complications in elderly patients with retroperitoneal tumors[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(10): 881-887.

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https://zhlcyszz.cma-cmc.com.cn/EN/Y2024/V18/I10/881

Figures/Tables 5

项目	数值
性别（女性/男性）	112/136
年龄（岁， $\overset{ˉ}{x}$ ±s）	69.7±4.4
身高（cm， $\overset{ˉ}{x}$ ±s）	164.4±7.9
体重（kg， $\overset{ˉ}{x}$ ±s）	62.8±10.8
初次/再次手术（例）	119/129
ASA分级[例（%）]
Ⅱ级	134（54.0）
Ⅲ级	106（43.0）
Ⅳ级	8（3.0）
术前合并症[例（%）]
高血压	90（36.0）
糖尿病	34（14.0）
冠心病	23（9.0）
陈旧性脑梗	12（5.0）
两种及以上合并症	62（25.0）
手术时长（min， $\overset{ˉ}{x}$ ±s）	287.2±132.0
麻醉时长（min， $\overset{ˉ}{x}$ ±s）	362.9±135.9

项目	数值
性别（女性/男性）	112/136
年龄（岁， $\overset{ˉ}{x}$ ±s）	69.7±4.4
身高（cm， $\overset{ˉ}{x}$ ±s）	164.4±7.9
体重（kg， $\overset{ˉ}{x}$ ±s）	62.8±10.8
初次/再次手术（例）	119/129
ASA分级[例（%）]
Ⅱ级	134（54.0）
Ⅲ级	106（43.0）
Ⅳ级	8（3.0）
术前合并症[例（%）]
高血压	90（36.0）
糖尿病	34（14.0）
冠心病	23（9.0）
陈旧性脑梗	12（5.0）
两种及以上合并症	62（25.0）
手术时长（min， $\overset{ˉ}{x}$ ±s）	287.2±132.0
麻醉时长（min， $\overset{ˉ}{x}$ ±s）	362.9±135.9

项目	数值
晶体液（ml， $\overset{ˉ}{x}$ ±s）	2941.9±1399.8
人工胶体液（ml， $\overset{ˉ}{x}$ ±s）	998.5±715.0
红细胞（U）	4（0，8）
血浆（ml）	400（0，800）
白蛋白（ml）	100（0，200）
液体平衡量（ml， $\overset{ˉ}{x}$ ±s）	2672.2±1657.7
凝血酶原复合物（U）	0（0，3000）
纤维蛋白原（g）	0（0，8）
住院总时长（d， $\overset{ˉ}{x}$ ±s）	38.0±21.9
术后住院时长（d， $\overset{ˉ}{x}$ ±s）	26.5±20.7
并发症[例（%）]
Ⅰ级	73（29.4）
Ⅱ级	79（31.9）
Ⅲ级	30（12.1）
Ⅳ级	10（4.0）
Ⅴ级	4（1.6）

项目	数值
晶体液（ml， $\overset{ˉ}{x}$ ±s）	2941.9±1399.8
人工胶体液（ml， $\overset{ˉ}{x}$ ±s）	998.5±715.0
红细胞（U）	4（0，8）
血浆（ml）	400（0，800）
白蛋白（ml）	100（0，200）
液体平衡量（ml， $\overset{ˉ}{x}$ ±s）	2672.2±1657.7
凝血酶原复合物（U）	0（0，3000）
纤维蛋白原（g）	0（0，8）
住院总时长（d， $\overset{ˉ}{x}$ ±s）	38.0±21.9
术后住院时长（d， $\overset{ˉ}{x}$ ±s）	26.5±20.7
并发症[例（%）]
Ⅰ级	73（29.4）
Ⅱ级	79（31.9）
Ⅲ级	30（12.1）
Ⅳ级	10（4.0）
Ⅴ级	4（1.6）

项目	术前	术后
Hb（g/L， $\overset{ˉ}{x}$ ±s）	114.2±17.5	103.5±15.1
血糖（mmol/L， $\overset{ˉ}{x}$ ±s）	5.9±2.1	9.1±2.3
乳酸（mmol/L， $\overset{ˉ}{x}$ ±s）	0.86±0.4	1.29±1.1
ALB（g/L， $\overset{ˉ}{x}$ ±s）	36.5±4.5	29.8±4.6
肌酐（μmol/L， $\overset{ˉ}{x}$ ±s）	74.2±23.3	79.8±27.7
PT（s， $\overset{ˉ}{x}$ ±s）	11.7±1.2	12.9±1.4
纤维蛋白原（g/L， $\overset{ˉ}{x}$ ±s）	400.0±127.7	315.3±88.1
NLR（ $\overset{ˉ}{x}$ ±s）	3.7±3.6	12.9±8.7

项目	术前	术后
Hb（g/L， $\overset{ˉ}{x}$ ±s）	114.2±17.5	103.5±15.1
血糖（mmol/L， $\overset{ˉ}{x}$ ±s）	5.9±2.1	9.1±2.3
乳酸（mmol/L， $\overset{ˉ}{x}$ ±s）	0.86±0.4	1.29±1.1
ALB（g/L， $\overset{ˉ}{x}$ ±s）	36.5±4.5	29.8±4.6
肌酐（μmol/L， $\overset{ˉ}{x}$ ±s）	74.2±23.3	79.8±27.7
PT（s， $\overset{ˉ}{x}$ ±s）	11.7±1.2	12.9±1.4
纤维蛋白原（g/L， $\overset{ˉ}{x}$ ±s）	400.0±127.7	315.3±88.1
NLR（ $\overset{ˉ}{x}$ ±s）	3.7±3.6	12.9±8.7

住院时长	术中输注PCC（IU）		术毕血糖（mmol/L）
住院时长	r值	P值	r值	P值
住院总时长	1.016	＜0.001	4.981	0.002
术后住院时长	1.019	＜0.001	3.695	0.008

临床病理因素	严重并发症		多因素分析
临床病理因素	是（n=44）	否（n=204）	r值	P值
性别女/男	11/33	101/103	3.666	0.002
人工胶体液（ml）	1000（500，2000）	1000（500，1000）	1.001	0.017
术毕乳酸（mmol/L）	1.1（0.75，2.1）	0.8（0.7，1.2）	1.627	0.001

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