Preoperative Point-of-Care Ultrasound to Identify Frailty and Predict Postoperative Outcomes: A Diagnostic Accuracy Study.
Preoperative Point-of-Care Ultrasound to Identify Frailty and Predict Postoperative Outcomes: A Diagnostic Accuracy Study.
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DOI：
10.1097/aln.0000000000004064
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发表时间：
2022-02-01
期刊：
影响因子：
8.8
通讯作者：
Singh, Sumit P.
中科院分区：
文献类型：
--
作者：
Canales, Cecilia;Mazor, Einat;Coy, Heidi;Grogan, Tristan R.;Duval, Victor;Raman, Steven;Cannesson, Maxime;Singh, Sumit P.
虚弱越来越被认为是一个公共卫生问题，使医疗资源紧张，并增加了照顾这些患者的成本。虚弱是身体和认知储备的下降，导致对手术或疾病状态等压力源的脆弱性增加。这项初步诊断准确性研究的目的是确定四头肌和股直肌的床旁超声测量是否可用于区分虚弱和非虚弱患者并预测术后结局。这项研究假设，超声可以区分虚弱和不虚弱的患者手术前。术前超声测量股四头肌和股直肌获得了先前的计算机断层扫描的患者。使用计算机断层扫描，腰大肌肌肉面积测量所有患者进行比较。使用Fried表型评估鉴定虚弱。术后结局包括计划外入住重症监护室、谵妄、重症监护室住院时间、住院时间、计划外入住专业护理机构、再住院、30天内福尔斯以及全因30天和1年死亡率。共纳入32例患者和20例健康志愿者。32例患者中有18例发现虚弱。受试者工作特征曲线分析显示，股四头肌深度和腰大肌面积能够识别虚弱（曲线下面积-受试者工作特征，分别为0.80 [95% CI，0.64 - 0.97]和0.88 [95% CI，0.76 - 1.00]），而股直肌的横截面积则不太有希望（曲线下面积-受试者工作特征，0.70 [95% CI，0.49 - 0.91]）。股四头肌深度也与计划外术后专业护理机构出院处置（曲线下面积0.81 [95%CI，0.61 - 1.00]）和谵妄（曲线下面积0.89 [95%CI，0.77 - 1.00]）相关。与腰大肌面积的计算机断层扫描测量相似，术前超声测量股四头肌深度有望在手术前区分虚弱和不虚弱的患者。这也与熟练的护理设施入院和术后谵妄有关。
Frailty is increasingly being recognized as a public health issue, straining healthcare resources and increasing costs to care for these patients. Frailty is the decline in physical and cognitive reserves leading to increased vulnerability to stressors such as surgery or disease states. The goal of this pilot diagnostic accuracy study was to identify whether point-of-care ultrasound measurements of the quadriceps and rectus femoris muscles can be used to discriminate between frail and not-frail patients and predict postoperative outcomes. This study hypothesized that ultrasound could discriminate between frail and not-frail patients before surgery. Preoperative ultrasound measurements of the quadriceps and rectus femoris were obtained in patients with previous computed tomography scans. Using the computed tomography scans, psoas muscle area was measured in all patients for comparative purposes. Frailty was identified using the Fried phenotype assessment. Postoperative outcomes included unplanned intensive care unit admission, delirium, intensive care unit length of stay, hospital length of stay, unplanned skilled nursing facility admission, rehospitalization, falls within 30 days, and all-cause 30-day and 1-yr mortality. A total of 32 patients and 20 healthy volunteers were included. Frailty was identified in 18 of the 32 patients. Receiver operating characteristic curve analysis showed that quadriceps depth and psoas muscle area are able to identify frailty (area under the curve–receiver operating characteristic, 0.80 [95% CI, 0.64 to 0.97] and 0.88 [95% CI, 0.76 to 1.00], respectively), whereas the cross-sectional area of the rectus femoris is less promising (area under the curve–receiver operating characteristic, 0.70 [95% CI, 0.49 to 0.91]). Quadriceps depth was also associated with unplanned postoperative skilled nursing facility discharge disposition (area under the curve 0.81 [95% CI, 0.61 to 1.00]) and delirium (area under the curve 0.89 [95% CI, 0.77 to 1.00]). Similar to computed tomography measurements of psoas muscle area, preoperative ultrasound measurements of quadriceps depth shows promise in discriminating between frail and not-frail patients before surgery. It was also associated with skilled nursing facility admission and postoperative delirium.