Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study.
Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study.
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老年评估可改善接受胰十二指肠切除术的老年人手术结果的预测：一项前瞻性队列研究。
DOI：
10.1097/sla.0000000000000226
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发表时间：
2014-05
影响因子：
9
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中科院分区：
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前瞻性评价老年评估（GA）在预测接受胰腺肿瘤胰管切除术（PD）的老年患者队列中的手术结局方面的附加价值。老年患者很少因可能的PD而转诊。标准的术前评估可能会低估严重不良结局的可能性。在这一组尚未研究验证GA的前瞻性效用。符合PD条件的患者入组前瞻性结局研究。记录标准的术前评估。验证遗传算法的元素也进行了测量，包括弗里德的脆弱模型的组件，脆弱的老年人调查（VES-13），和短期物理性能电池（SPPB）。记录所有术后不良事件，由对GA结果不知情的外科医生使用Clavien-Dindo系统进行系统审查和分级。进行多变量回归分析。76例老年患者接受了PD。在基线时识别出了显著的未识别的脆弱性：Fried的“衰竭”（37.3%），SPPB <10（28.5%）和VES-13 >3（15.4%）。PD后30天内，46%的人出现了严重并发症（Clavien-Dindo分级≥III）。在控制年龄、体重指数、美国麻醉医师协会评分和合并症负担的回归分析中，Fried的“衰竭”预测了严重并发症[比值比（OR）= 4.06; P = 0.01]、住院时间更长（β = 0.27; P = 0.02）和外科重症监护室入院（OR = 4.30; P = 0.01）。SPPB（OR = 0.61; P = 0.04）和年龄越大，出院到康复机构的可能性越小（OR = 1.1; P < 0.05），年龄与再入院的可能性越低（OR = 0.94; P = 0.02）。控制标准术前评估，GA评分越差，前瞻性和独立预测重要的不良结局。老年评估可能有助于识别PD并发症高风险的老年患者。
To prospectively evaluate the additional value of geriatric assessment (GA) for predicting surgical outcomes in a cohort of older patients undergoing a pancreaticoduodenectomy (PD) for pancreatic tumors. Older patients are less often referred for possible PD. Standard preoperative assessments may underestimate the likelihood of significant adverse outcomes. The prospective utility of validated GA has not been studied in this group. PD-eligible patients were enrolled in a prospective outcome study. Standard preoperative assessments were recorded. Elements of validated GA were also measured, including components of Fried’s model of frailty, the Vulnerable Elders Survey (VES-13), and the Short Physical Performance Battery (SPPB). All postoperative adverse events were recorded, systematically reviewed, and graded using the Clavien-Dindo system by a surgeon blinded to the GA results. Multivariate regression analyses were conducted. Seventy-six older patients underwent a PD. Significant unrecognized vulnerability was identified at the baseline: Fried’s “exhaustion” (37.3%), SPPB <10 (28.5%), and VES-13 >3 (15.4%). Within 30 days of PD, 46% experienced a severe complication (Clavien-Dindo grade ≥III). In regression analyses controlling for age, the body mass index, the American Society of Anesthesiologists score, and comorbidity burden, Fried’s “exhaustion” predicted major complications [odds ratio (OR) = 4.06; P = 0.01], longer hospital stays (β = 0.27; P = 0.02), and surgical intensive care unit admissions (OR = 4.30; P = 0.01). Both SPPB (OR = 0.61; P = 0.04) and older age predicted discharge to a rehabilitation facility (OR = 1.1; P < 0.05) and age correlated with a lower likelihood of hospital readmission (OR = 0.94; P = 0.02). Controlling for standard preoperative assessments, worse scores on GA prospectively and independently predicted important adverse outcomes. Geriatric assessment may help identify older patients at high risk for complications from PD.