Frailty as a Predictor of Surgical Outcomes in Older Patients
Frailty as a Predictor of Surgical Outcomes in Older Patients
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DOI：
10.1016/j.jamcollsurg.2010.01.028
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发表时间：
2010-06-01
影响因子：
5.2
通讯作者：
Fried, Linda P.
中科院分区：
文献类型：
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作者：
Makary, Martin A.;Segev, Dorry L.;Fried, Linda P.
背景：术前风险评估对老年患者很重要，但不准确，因为生理储备很难测量。虚弱被认为是估计生理储备，虽然它的使用还没有在手术患者进行评估。我们设计了一项研究，以确定是否脆弱预测手术并发症，并提高目前围手术期的风险models.Study设计：我们前瞻性地测量脆弱的594例患者（年龄65岁或以上）提出了一所大学医院的择期手术2005年7月至2006年7月。使用经验证的量表（0至5）对虚弱进行分类，包括虚弱、体重减轻、疲惫、体力活动少和步行速度减慢。评分为4 ~ 5分的患者被归类为虚弱，2 ~ 3分的患者被归类为中度虚弱，0 ~ 1分的患者被归类为非虚弱。主要结果指标为30天手术并发症、住院时间和出院处置。多元logistic回归（并发症和出院）和负二项回归结果：术前虚弱与术后并发症的风险增加相关（中度虚弱：比值比[OR] 2.06; 95% CI 1.18-3.60;虚弱：OR 2.54; 95% CI 1.12 - 5.77），住院时间（中度体弱：发病率比1.49; 95% CI 1.24-1.80;体弱：发病率比1.69; 95% CI 1.28-2.23），并且在以前在家生活后出院至技术或辅助生活设施（中度虚弱：OR 3.16; 95% CI 1.0-9.99;虚弱：OR 20.48; 95% CI 5.54-75.68）。虚弱改善了每个风险指数的预测能力（p < 0.01）（即，美国麻醉医师协会，Lee和Eagle scores）。结论：虚弱独立预测老年手术患者的术后并发症，住院时间和出院到熟练或辅助生活设施，并增强了传统的风险模型。使用标准化定义评估虚弱可以帮助患者和医生做出更明智的决定。（美国科尔外科杂志2010;210：901-908。(C)2010年美国外科医生学会）
BACKGROUND: Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure. Frailty is thought to estimate physiologic reserves, although its use has not been evaluated in surgical patients. We designed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models.STUDY DESIGN: We prospectively measured frailty in 594 patients (age 65 years or older) presenting to a university hospital for elective surgery between July 2005 and July 2006. Frailty was classified using a validated scale (0 to 5) that included weakness, weight loss, exhaustion, low physical activity; and slowed walking speed. Patients scoring 4 to 5 were classified as frail, 2 to 3 were intermediately frail, and 0 to I were nonfrail. Main outcomes measures were 30-day surgical complications, length of stay, and discharge disposition. Multiple logistic regression (complications and discharge) and negative binomial regression (length of stay) were done to analyze frailty and postoperative outcomes associations.RESULTS: Preoperative frailty was associated with an increased risk for postoperative complications (intermediately frail: odds ratio [OR] 2.06; 95% CI 1.18-3.60; frail: OR 2.54; 95% CI 1.12 5.77), length of stay (intermediately frail: incidence rate ratio 1.49; 95% CI 1.24-1.80; frail: incidence rate ratio 1.69; 95% CI 1.28-2.23), and discharge to a skilled or assisted-living facility after previously living at home (intermediately frail: OR 3.16; 95% CI 1.0-9.99; frail: OR 20.48; 95% CI 5.54-75.68). Frailty improved predictive power (p < 0.01) of each risk index (ie, American Society of Anesthesiologists, Lee, and Eagle scores).CONCLUSIONS: Frailty independently predicts postoperative complications, length of stay, and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models. Assessing frailty using a standardized definition can help patients and physicians make more informed decisions. (J Am Coll Surg 2010;210:901-908. (C) 2010 by the American College of Surgeons)