Low Self-Reported Function Predicts Adverse Postoperative Course in Veterans Affairs Beneficiaries Undergoing Total Hip and Total Knee Replacement.
Low Self-Reported Function Predicts Adverse Postoperative Course in Veterans Affairs Beneficiaries Undergoing Total Hip and Total Knee Replacement.
复制标题
低自我报告功能预示着接受全髋关节和全膝关节置换术的退伍军人事务受益人术后不良过程。
DOI：
10.1111/jgs.14020
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发表时间：
2016
影响因子：
6.3
通讯作者：
Berlowitz,DanR
中科院分区：
文献类型：
--
作者：
Kapoor,Alok;Chew,PriscillaW;Reisman,JoelI;Berlowitz,DanR
目的在美国外科医师学会通用风险计算器（ACS计算器）上测量自我报告功能与术后不良病程之间的关系，并通过基于退伍军人Rand - 12的身体成分总结（PCS）和心理成分总结（MCS）评分来评估自我报告功能。DesignCohort分析。设置退伍军人事务卫生系统。2002年至2009年接受髋关节和膝关节置换术的老年男性退伍军人的手术（n = 3503）。严重并发症（根据ACS定义），出院，再入院，术后30天内死亡作为PCS和MCS的功能；使用改良版ACS计算器预测严重并发症净重分类指数（NRI）与添加MCS和PCS的ACS计算器预测NRI的比较。结果处于最低PCS四分位数（vs最高PCS四分位数）的患者发生严重并发症的风险是其两倍以上(优势比（OR) = 2.27, 95%可信区间(CI) = 1.44-3.58），出院风险是其两倍（OR = 1.97, 95% CI = 1.39-2.79），再入院风险几乎是其两倍（OR = 1.80, 95% CI = 1.37-2.36）。MCS的最低四分位数预测了每一种结果，尽管其程度低于PCS。增强模型的NRI为29.4% (95% CI = 15.4-43.3%)，反映出20.8%的事件被适当升级，8.6%的非事件被适当降级。结论低PCS和MCS可预测术后不良病程，提高ACS计算能力。临床医生评估接受骨科手术的老年人可以通过包括自我报告的功能状态来提高他们评估的准确性。
ObjectivesTo measure association between self‐reported function and an adverse postoperative course and improvement in performance on the American College of Surgeons Universal Risk Calculator (ACS calculator) with inclusion of self‐reported function available through the Veteran Rand‐12 based Physical Component Summary (PCS) and Mental Component Summary (MCS) scores.DesignCohort analysis.SettingVeteran Affairs health system.ParticipantsSurgeries (n = 3,503) for older male veterans undergoing hip and knee replacement from 2002 to 2009.MeasurementsSerious complication (per ACS definition), discharge to facility, readmission, and death within 30 days after surgery as a function of PCS and MCS; comparison of prediction of net reclassification index (NRI) for serious complication using a modified version of the ACS calculator with prediction using the ACS calculator with MCS and PCS added.ResultsBeing in the lowest PCS quartile (vs highest quartile) predicted more than twice the risk of a serious complication (odds ratio (OR) = 2.27, 95% confidence interval (CI) = 1.44–3.58), twice the risk of discharge to facility (OR = 1.97, 95% CI = 1.39–2.79), and almost twice the risk of readmission (OR = 1.80, 95% CI = 1.37–2.36). The lowest quartile of MCS predicted each outcome, although to a lesser extent than PCS. The enhanced model had a NRI of 29.4% (95% CI = 15.4–43.3%), reflecting that 20.8% of events were appropriately upgraded and 8.6% of nonevents appropriately downgraded.ConclusionLow PCS and MCS predicted an adverse postoperative course and enhanced the ACS calculator. Clinicians evaluating older adults undergoing orthopedic surgery could enhance the accuracy of their assessments by including self‐reported functional status.