Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized
Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized
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DOI：
10.1016/j.amjsurg.2011.08.012
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发表时间：
2012-08-01
影响因子：
3
通讯作者：
Tang, Terence
中科院分区：
文献类型：
--
作者：
Tan, Kok-Yang;Kawamura, Yutaka J.;Tang, Terence
背景技术背景：通过评估体重减轻、步态速度、握力、体力活动和体力衰竭确定的虚弱临床综合征已用于确定储备减少的患者。我们假设，脆弱是有用的预测不良结果在优化的选择老年结直肠手术patients.METHODS：一项前瞻性研究进行了2个中心（新加坡和日本）。对所有75岁以上接受结直肠切除术的患者进行虚弱综合征评估。所有这些患者的合并症均已针对手术进行了优化。结果指标为术后主要并发症（定义为Clavien-Dindo II型及以上并发症）。结果：从2008年2月至2010年4月共研究了83例患者。平均年龄为81.5岁（范围75-93岁）。平均合并症指数为3.37（范围0-11）。26例（31.3%）患者的美国麻醉医师协会（阿萨）评分为3分及以上。卡方分析显示，当患者满足虚弱标准时，术后严重并发症的比值比为4.083（95%置信区间，1.433-11.638）。白蛋白3，并发症指数>5，生理和手术严重程度评分的死亡率和死亡率（POSSUM）评分的enUmeration不能预测术后主要complications.CONCLUSIONS：初步研究结果表明，虚弱是一个有效的预测术后发病率的工具。虚弱可用于识别需要在大手术前进一步优化的老年患者。(C)2012 Elsevier Inc. All rights reserved.
BACKGROUND: The clinical syndrome of frailty identified through the assessment of weight loss, gait speed, grip strength, physical activity, and physical exhaustion has been used to identify patients with reduced reserves. We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients.METHODS: A prospective study was conducted at 2 centers (Singapore and Japan). All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty. All these patients had already had their comorbidities optimized for surgery. The outcome measure was postoperative major complications (defined as Clavien-Dindo type II and above complications).RESULTS: Eighty-three patients were studied from February 2008 to April 2010. The mean age was 81.5 years (range 75-93 years). The mean comorbidity index was 3.37 (range 0-11). Twenty-six (31.3%) patients were an American Society of Anesthesiologists (ASA) score of 3 and above. Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 (95% confidence interval, 1.433-11.638) when the patient satisfied the criteria for frailty. Albumin 3, comorbidity index >5, and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scores were not predictive of postoperative major complications.CONCLUSIONS: Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity. Frailty can be used to identify elderly patients needing further optimization before major surgery. (C) 2012 Elsevier Inc. All rights reserved.