术前衰弱状态对老年肝部分切除术后切口感染的影响

doi:10.3969/j.issn.1003-9198.2026.05.011

摘要/Abstract

摘要： 目的探讨术前衰弱状态对老年肝部分切除术后切口感染的影响,并分析切口感染相关危险因素。方法选取2024年1—12月江苏省人民医院肝胆中心拟择期行肝部分切除术且年龄≥60岁的患者224例。入院当天采用FRAIL量表评估衰弱状态(≥3分判定为衰弱)。收集患者一般资料、合并症、术前实验室检查指标及手术相关指标,以是否发生术后切口感染分组进行比较,并采用多因素logistic回归分析探讨切口感染的独立危险因素。结果 224例患者中衰弱61例、非衰弱163例,术前衰弱发生率为27.23%。术后切口感染28例(12.50%),衰弱组切口感染发生率显著高于非衰弱组(29.51%比6.13%,P＜0.001)。多因素logistic回归分析显示:术前衰弱(OR=7.720,95%CI:1.502～39.671)、术前CRP升高(OR=3.399,95%CI:1.971～5.861)、血小板/淋巴细胞比值(PLR)增高(OR=1.026,95%CI:1.009～1.044)及手术时间延长(OR=1.019,95%CI:1.007～1.031)为切口感染的独立危险因素。结论术前衰弱可显著增加老年肝部分切除术后切口感染风险。围手术期应加强术前衰弱筛查与风险分层,并结合炎症指标与手术时长等因素实施针对性管理,以降低切口感染发生风险。

关键词: 衰弱, 老年人, 肝部分切除术, 切口感染

Abstract: Objective To investigate the impact of preoperative frailty on surgical site infection (SSI) after partial hepatectomy in elderly patients, and to identify associated risk factors for infection. Methods A total of 224 patients aged ≥60 years who were scheduled for elective partial hepatectomy at the Hepatobiliary Center of Jiangsu Province Hospital from January to December 2024 were enrolled. Preoperative frailty was assessed on admission using the FRAIL scale (frailty defined as a score ≥3). Data on demographics, comorbidities, preoperative laboratory indices, and perioperative variables were collected. Patients were grouped according to the occurrence of postoperative SSI for comparison. Multivariable logistic regression analysis was used to identify independent risk factors for SSI. Results Among the 224 patients, 61 were frail and 163 were non-frail, with a preoperative frailty prevalence of 27.23%. Postoperative SSI occurred in 28 patients (12.50%). The incidence rate of SSI was significantly higher in the frailty group than that in the non-frailty group (29.51% vs 6.13%, P<0.001). Multivariable logistic regression identified that preoperative frailty (OR=7.720, 95%CI: 1.502-39.671, P=0.014), elevated preoperative C-reactive protein (OR=3.399, 95%CI: 1.971-5.861), higher platelet-to-lymphocyte ratio (OR=1.026, 95%CI: 1.009-1.044), and longer operative time (OR=1.019, 95%CI: 1.007-1.031) were independent risk factors for SSI. Conclusions Preoperative frailty significantly increases the risk of SSI in elderly patients undergoing partial hepatectomy. Routine preoperative frailty screening and risk stratification, together with targeted perioperative management incorporating inflammatory markers and operative time, may help reduce the incidence of SSI.

Key words: frailty, aged, partial hepatectomy, incision infection

中图分类号:

R 735.7

许云秋, 王蓓, 杨春静. 术前衰弱状态对老年肝部分切除术后切口感染的影响[J]. 实用老年医学, 2026, 40(5): 490-494.

XU Yunqiu, WANG Bei, YANG Chunjing. Impact of preoperative frailty on surgical site infection in elderly patients undergoing partial hepatectomy[J]. Practical Geriatrics, 2026, 40(5): 490-494.

参考文献

[1] 蒲婧瑜, 于丽红, 姬琳, 等. 老年衰弱综合征的中西医研究进展[J]. 实用中医内科杂志, 2024, 38(4): 51-54.
[2] XUE Q L. The frailty syndrome: definition and natural history[J]. Clin Geriatr Med, 2011, 27(1): 1-15.
[3] 陈静, 王晓玲, 安康, 等. 老年衰弱与代谢综合征关系的研究进展[J]. 老年医学与保健, 2023, 29(6): 1374-1377.
[4] 李倩, 肖谦. 老年人共病与衰弱的研究进展[J]. 实用老年医学, 2022, 36(6): 619-622.
[5] 姚辉华, 陈星宇, 赖威, 等. 老年病人肝切除手术后肺部并发症发生的危险因素分析[J]. 临床外科杂志, 2023, 31(3): 247-250.
[6] 姜秋艳, 薛梅. 肝切除术后切口感染的危险因素分析[J]. 中国医学前沿杂志:电子版, 2020, 12(6): 121-124.
[7] 万莹, 申雪花. 老年患者衰弱评估的研究进展[J]. 中国老年学杂志, 2024, 44(17): 4349-4351.
[8] OROUJI JOKAR T, IBRAHEEM K, RHEE P, et al. Emergency general surgery specific frailty index: a validation study[J]. J Trauma Acute Care Surg, 2016, 81(2): 254-260.
[9] SHINALL M C Jr, ARYA S, YOUK A, et al. Association of preoperative patient frailty and operative stress with postoperative mortality[J]. JAMA Surg, 2020, 155(1): e194620.
[10] DENT E, MARTIN F C, BERGMAN H, et al. Management of frailty: opportunities, challenges, and future directions[J]. Lancet, 2019, 394(10206): 1376-1386.
[11] 夏魁, 孙伟, 陆民, 等. 衰弱对高龄患者肺部感染的影响[J]. 中国临床保健杂志, 2024, 27(5): 639-642.
[12] 许伟, 吴剑卿. 衰弱综合征与老年肺部感染[J]. 实用老年医学, 2022, 36(8): 784-787.
[13] JIA H, HUANG W, LIU C, et al. Immunosenescence is a therapeutic target for frailty in older adults: a narrative review[J]. Ann Transl Med, 2022, 10(20): 1142.
[14] SETH I, LIM B, CEVIK J, et al. Impact of nutrition on skin wound healing and aesthetic outcomes: a comprehensive narrative review[J]. JPRAS Open, 2024, 39: 291-302.
[15] MANZETTI M, RUFFILLI A, VIROLI G, et al. Frailty influence on postoperative surgical site infections after surgery for degenerative spine disease and adult spine deformity. Can a frailty index be a valuable summary risk indicator? A systematic review and metanalysis of the current literature[J]. Global Spine J, 2025, 15(2): 1338-1355.
[16] YASUDA S, HOKUTO D, KAMITANI N, et al. Pre-and postoperative C-reactive protein as a risk factor of organ/space surgical site infection after hepatectomy[J]. Langenbecks Arch Surg, 2023, 408(1): 13.
[17] ZHUO Y, CAI D, CHEN J, et al. Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia[J]. Medicine, 2021, 100(9): e25007.
[18] STIDHAM K, NAFTCHI A F, SPIROLLARI E, et al. Frailty is superior to age for predicting readmission, prolonged length of stay, and wound infection in elective otology procedures[J]. Otol Neurotol, 2022, 43(8): 937-943.
[19] NI LOCHLAINN M, COX N J, WILSON T, et al. Nutrition and frailty: opportunities for prevention and treatment[J]. Nutrients, 2021, 13(7): 2349.
[20] CALDER P C. Nutrition and immunity: lessons from coronavirus disease-2019[J]. Proc Nutr Soc, 2025, 84(1):8-23.
[21] WANG Y L, ZHANG F B, ZHENG L E, et al. Enhanced recovery after surgery care to reduce surgical site wound infection and postoperative complications for patients undergoing liver surgery[J]. Int Wound J, 2023, 20(9): 3540-3549.
[22] LIU L, ZHANG M, ZHANG X, et al. Effects of enhance recovery after surgery nursing program on the surgical site wound infection in patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma: a meta-analysis[J]. Int Wound J, 2024, 21(3): e14490.