Preoperative Frailty and Quality of Life as Predictors of Postoperative Complications
Preoperative Frailty and Quality of Life as Predictors of Postoperative Complications
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DOI：
10.1097/sla.0b013e318214bce7
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发表时间：
2011-06-01
影响因子：
9
通讯作者：
Velanovich, Vic
中科院分区：
文献类型：
--
作者：
Saxton, Adrienne;Velanovich, Vic
背景：术后并发症的预测是基于对合并症的评估。然而，对这些合并症的评估并没有一致地确定出那些并发症风险较高的患者，主要是因为无法评估这些合并症如何影响功能状态。我们假设术前对患者健康状况的功能测量可以预测术后并发症。方法：对接受普通外科手术的患者样本进行年龄、性别、诊断（严重程度）、手术（复杂程度）、合并症数量、术前虚弱（由加拿大健康和老龄化虚弱指数研究确定）、术前生活质量（由SF-36确定）、术后并发症的发生、术后并发症的数量和并发症的严重程度进行回顾。数据分析采用线性和多元logistic回归分析，并采用Mann-Whitney U检验。结果：共纳入226例患者，平均年龄61±13岁，男性占47%。衰弱指数（FI）与合并症的数量相关（r = 0.61, P < 0.001），与SF-36的所有域相关。术后并发症患者术前FI中位数高于无并发症患者[0.075 （IQR 0.046-0.118）比0.059 (IQR 0.045-0.089), P = 0.007]。多元logistic回归分析表明，手术复杂性、FI和角色情绪域与术后并发症风险增加相关，而身体疼痛域与术后并发症风险降低相关。结论：本研究表明术前功能状态的FI和SF-36测量可能有助于识别术后并发症高风险患者。在我们的老龄化人口中，使用这些措施可能有助于更好地选择患者。
Background: Prediction of postoperative complications has been based on assessing comorbidities. However, the evaluation of these comorbidities has not consistently identified those at higher risk of complications, primarily due to the inability to assess how these comorbidities affect functional status. We hypothesized that preoperative functional measures of patients' health status can predict postoperative complications.Methods: A sample of patients undergoing general surgical operations were reviewed for age, gender, diagnosis (for severity), operations (for complexity), number of comorbidities, preoperative frailty (as determined by the Canadian Study of Health and Ageing Frailty Index), preoperative quality of life (as determined by the SF-36), occurrence of postoperative complications, number of postoperative complications, and severity of complications. Data were analyzed by linear and multiple logistic regression analyses, and the Mann-Whitney U test.Results: Two hundred and twenty-six patients were evaluated, average age 61 +/- 13 years, 47% male patients. Frailty Index (FI) correlated with number of comorbidities (r = 0.61, P < 0.001), and all of the domains of the SF-36. Patients who had postoperative complications had higher median preoperative FI than those would did not [0.075 (IQR 0.046-0.118) vs. 0.059 (IQR 0.045-0.089), P = 0.007]. Multiple logistic regression analysis demonstrated that operation complexity, FI, and the role-emotional domain were associated with and increased risk of postoperative complications, whereas the bodily pain domain was associated with a lower risk of postoperative complications.Conclusions: This study demonstrates that preoperative functional status as measured by FI and SF-36 may help identify patients at higher risk of postoperative complications. In our ageing population, use of such measures may help in better patient selection.