Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair
Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair
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DOI：
10.1016/j.jvs.2010.10.111
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发表时间：
2011-04-01
影响因子：
4.3
通讯作者：
Eliason, Jonathan L.
中科院分区：
文献类型：
--
作者：
Lee, Jay Soong-Jin;He, Kevin;Eliason, Jonathan L.
目的：确定主动脉手术患者的手术风险是一个困难的过程，因为多个变量汇聚在一起影响总死亡率。病人的虚弱当然是一个影响因素，但很难衡量，因为外科医生往往依赖于主观或直觉的影响。我们试图使用核心肌肉大小作为虚弱的客观衡量标准，并确定其作为腹主动脉瘤（AAA）修复后生存预测指标的效用。方法：2000年至2008年间，479例患者接受了选择性开放式AAA修补术。262例患者（54.7%）术前有计算机断层扫描（CT）可用于分析。测量腰4椎水平腰肌的横截面积。采用Cox回归评估腰大肌面积对术后死亡率的协变量调整效应。结果：262例患者中，死亡55例，平均随访时间2.3年。Cox回归显示腰肌面积与术后死亡率有显著相关性（P = 0.003）。随着随访时间的延长，腰大肌面积的影响显著降低（P = 0.008）。在Cox模型中包含的所有协变量中（包括死亡率预测因子，如美国麻醉医师学会[ASA]评分），腰肌面积是最显著的。结论：核心肌大小是衡量虚弱程度的客观指标，与选择性AAA修复后的死亡率密切相关。更好地了解脆弱和核心肌肉大小的作用可能有助于风险分层和影响手术修复的时机，特别是在更复杂的主动脉手术中。（中华外科杂志2011；53:912-7）
Objectives: Determining operative risk in patients undergoing aortic surgery is a difficult process, as multiple variables converge to affect overall mortality. Patient frailty is certainly a contributing factor, but is difficult to measure, with surgeons often relying on subjective or intuitive influences. We sought to use core muscle size as an objective measure of frailty, and determine its utility as a predictor of survival after abdominal aortic aneurysm (AAA) repair.Methods:Four hundred seventy-nine patients underwent elective open AAA repair between 2000 and 2008. Two hundred sixty-two patients (54.7%) had preoperative computed tomography (CT) scans available for analysis. Cross-sectional areas of the psoas muscles at the level of the L4 vertebra were measured. The covariate-adjusted effect of psoas area on postoperative mortality was assessed using Cox regression.Results: Of the 262 patients, there were 55 deaths and the mean length of follow-up was 2.3 years. Cox regression revealed a significant association between psoas area and postoperative mortality (P = .003). The effect of psoas area was found to decrease significantly as follow-up time increased (P = .008). Among all covariates included in the Cox models (including predictors of mortality such as American Society of Anesthesiologists [ASA] score), the psoas area was the most significant.Conclusion: Core muscle size, an objective measure of frailty, correlates strongly with mortality after elective AAA repair. A better understanding of the role of frailty and core muscle size may aid in risk stratification and impact timing of surgical repair, especially in more complex aortic operations. (J Vasc Surg 2011;53:912-7.)