The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery
The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery
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DOI：
10.1002/lary.28006
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发表时间：
2020-02-01
期刊：
影响因子：
2.6
通讯作者：
Suh, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Goel, Alexander N.;Lee, Jivianne T.;Suh, Jeffrey D.
目标/假设 虚弱是衡量生理储备减少的指标，与老年手术患者的不良后果相关。我们的目的是测量接受鼻鼻癌手术的患者术前虚弱与结果的关系。研究设计回顾性队列研究。方法 我们在全国再入院数据库中确定了 2010 年至 2014 年接受鼻鼻癌手术的 5,346 名患者。使用约翰霍普金斯大学调整临床组衰弱定义诊断指标来定义衰弱。使用多变量回归分析虚弱与术后结果的关联。结果 7.4% 的患者出现虚弱症状。虚弱是重症监护病房级别并发症（比值比 [OR]：4.83；95% 置信区间 [CI]：2.95-7.93；P < .001）和非回家出院（OR：3.07；95% CI：1.68-5.60；P < .001）的显着独立预测因素。与非体弱患者相比，体弱患者的中位住院时间长三倍（12 天 vs. 4 天；P < .001），中位住院费用高出两倍多（44,408 美元 vs. 18,660 美元；P < .001）。在预测严重并发症、非回家出院、住院时间和住院费用方面，虚弱优于晚期合并症（定义为 Charlson-Deyo 评分 >= 3）、年龄 >= 80 岁和手术复杂性标志物（例如颅底/眼眶受累、皮瓣重建、颈清扫术）。结论 与年龄或合并症指数相比，虚弱似乎与鼻腔癌手术后的不良后果和资源利用率增加具有更强、更一致的关联。该信息可用于手术风险分层，并可指导预防或减轻该高风险人群不良事件的策略。证据水平 NA 喉镜，130:290-296, 2020
Objectives/Hypothesis Frailty is a measure of decreased physiologic reserve that has been associated with adverse outcomes in older surgical patients. We aimed to measure the association of preoperative frailty with outcomes in patients undergoing sinonasal cancer surgery. Study Design Retrospective cohort study. Methods We identified 5,346 patients in the Nationwide Readmissions Database undergoing sinonasal cancer surgery from 2010 to 2014. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multivariate regression was used to analyze the association of frailty with postoperative outcomes. Results Frailty was present in 7.4% of patients. Frailty was a significant independent predictor of intensive care unit-level complications (odds ratio [OR]: 4.83; 95% confidence interval [CI]: 2.95-7.93; P < .001) and nonhome discharge (OR: 3.07; 95% CI: 1.68-5.60; P < .001). Compared to nonfrail patients, frail patients had threefold longer median length of stay (12 days vs. 4 days; P < .001) and more than twofold higher median hospital costs ($44,408 vs. $18,660; P < .001). Frailty outperformed advanced comorbidity (defined as Charlson-Deyo score >= 3), age >= 80 years, and markers of surgical complexity (e.g., skull base/orbit involvement, flap reconstruction, neck dissection) in predicting serious complications, nonhome discharge, length of stay, and hospital costs. Conclusions Frailty appears to have a stronger and more consistent association with adverse outcomes and increased resource utilization after sinonasal cancer surgery than age or comorbidity index. This information may be used in surgical risk stratification and can guide strategies to prevent or mitigate adverse events in this high-risk group. Level of Evidence NA Laryngoscope, 130:290-296, 2020