Assessment of the Risk Analysis Index for Prediction of Mortality, Major Complications, and Length of Stay in Patients who Underwent Vascular Surgery.
Assessment of the Risk Analysis Index for Prediction of Mortality, Major Complications, and Length of Stay in Patients who Underwent Vascular Surgery.
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DOI：
10.1016/j.avsg.2020.01.015
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发表时间：
2020-07
影响因子：
1.5
通讯作者：
Arya S
中科院分区：
文献类型：
--
作者：
Rothenberg KA;George EL;Trickey AW;Barreto NB;Johnson TM 2nd;Hall DE;Johanning JM;Arya S
虚弱是术后不良结果的危险因素。我们的目的是在血管手术患者中测试一种前瞻性验证的衰弱指标——风险分析指数（RAI）的性能，并描述手术复杂性对手术结果的附加影响。我们查询了2007-2013年美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库，确定了六种主要的选择性血管手术类别（颈动脉血管重建术、腹主动脉瘤（AAA）修复、腹沟上血管重建术、腹沟下血管重建术、胸主动脉瘤（TAA）修复和胸腹主动脉瘤（TAAA）修复）。我们训练并测试了30天死亡率、主要并发症和延长住院时间（LOS）的逻辑回归模型。第一个模型“RAI”仅使用RAI；“RAI-Procedure （RAI-P）”包括手术类别（如AAA修复）和手术入路（如血管内）；“rai -手术复杂性（RAI-PC）”增加了门诊与住院手术、全身麻醉使用、工作相对价值单位（RVUs）和手术时间。RAI模型可以很好地预测血管手术的总体死亡率（c统计量为0.72）。c统计量随RAI-P（0.78）而增加，随RAI-PC（0.79）而进一步略有改善。当按手术类别分层时，RAI对腹股沟下手术（0.79）和腹股沟上手术（0.74）的死亡率预测良好，对AAA修复（0.69）和颈动脉血运重建术（0.70）的预测较好，对TAAs（0.62）和taaa（0.54）的预测较差。对于颈动脉、腹股沟下和腹股沟上手术，手术复杂性（RAI-PC）对死亡率的模型判别影响不大，但确实提高了对AAAs（0.84）、TAAs（0.73）和TAAs（0.80）的判别。虽然RAI模型不能很好地预测主要并发症或LOS，但RAI- pc模型改善了两者的辨别能力。由RAI测量的虚弱是血管手术后死亡率的一个很好的预测指标。虽然RAI不是主要并发症或长期LOS的有力预测指标，但随着手术类别和方法等手术特征的增加，模型得到了改进。
Frailty is a risk factor for adverse postoperative outcomes. We aimed to test the performance of a prospectively-validated frailty measure, the Risk Analysis Index (RAI) in vascular surgery patients and delineate the additive impact of procedure complexity on surgical outcomes. We queried the 2007–2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify six major elective vascular procedure categories (carotid revascularization, abdominal aortic aneurysm [AAA] repair, suprainguinal revascularization, infrainguinal revascularization, thoracic aortic aneurysm [TAA] repair, and thoracoabdominal aortic aneurysm [TAAA] repair). We trained and tested logistic regression models for 30-day mortality, major complications and prolonged length of stay (LOS). The first model, “RAI”, used the RAI alone; “RAI-Procedure (RAI-P)” included procedure category (e.g., AAA repair) and procedure approach (e.g., endovascular); “RAI-Procedure Complexity (RAI-PC)” added outpatient versus inpatient surgery, general anesthesia use, work relative value units (RVUs), and operative time. The RAI model was a good predictor of mortality for vascular procedures overall (C-statistic 0.72). The C-statistic increased with the RAI-P (0.78), which further improved minimally, with the RAI-PC (0.79). When stratified by procedure category, the RAI predicted mortality well for infrainguinal (0.79) and suprainguinal (0.74) procedures, moderately well for AAA repairs (0.69) and carotid revascularizations (0.70), and poorly for TAAs (0.62) and TAAAs (0.54). For carotid, infrainguinal, and suprainguinal procedures, procedure complexity (RAI-PC) had little impact on model discrimination for mortality, did improve discrimination for AAAs (0.84), TAAs (0.73), and TAAAs (0.80). While the RAI model was not a good predictor for major complications or LOS, discrimination improved for both with the RAI-PC model. Frailty as measured by the RAI was a good predictor of mortality overall after vascular surgery procedures. While the RAI was not a strong predictor of major complications or prolonged LOS, the models improved with the addition of procedure characteristics like procedure category and approach.
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影响因子：
4.3
作者：
Morisaki, Koichi;Yamaoka, Terutoshi;Ohmine, Takahiro
通讯作者：
Ohmine, Takahiro
影响因子：
3.9
作者：
Neupane, Iva;Arora, Rakesh C.;Rudolph, James L.
通讯作者：
Rudolph, James L.
影响因子：
4.3
作者：
Arya, Shipra;Kim, Sung In;Dodson, Thomas F.
通讯作者：
Dodson, Thomas F.
影响因子：
4.3
作者：
Donald, Graham W.;Ghaffarian, Amir A.;Brooke, Benjamin S.
通讯作者：
Brooke, Benjamin S.
DOI：
10.1016/j.jamcollsurg.2013.05.015
发表时间：
2013-10-01
影响因子：
5.2
作者：
Merkow, Ryan P.;Bentrem, David J.;Bilimoria, Karl Y.
通讯作者：
Bilimoria, Karl Y.