Frailty as a Predictor of Death or New Disability After Surgery A Prospective Cohort Study
Frailty as a Predictor of Death or New Disability After Surgery A Prospective Cohort Study
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DOI：
10.1097/sla.0000000000002967
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发表时间：
2020-02-01
影响因子：
9
通讯作者：
Forster, Alan J.
中科院分区：
文献类型：
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作者：
McIsaac, Daniel I.;Taljaard, Monica;Forster, Alan J.
目的：比较改良的Fried指数（mFI）和临床虚弱量表（CFS）预测重大择期手术后90天死亡或患者报告的新残疾的准确性。背景：虚弱与患者报告的结果之间的关联，以及术前虚弱仪器之间的比较都没有得到很好的描述。方法：这是一项前瞻性多中心队列研究。我们使用mFI和CFS来确定bb0 = 65岁的选择性非心脏手术患者的虚弱状态。结局包括死亡或患者报告的新残疾（原发性）；安全事故、住院时间（LOS）和机构出院（二级）；易用性、实用性、益处、临床重要性和可行性（第三级）。我们使用回归分析测量了虚弱与结果的校正相关性，并比较了真阳性率和假阳性率（TPR/FPR）。结果：702名参与者中，645人完成了随访。CFS确定297例（42.3%）虚弱，mFI 257例（36.6%）；72人（11.1%）死亡或经历新的残疾。虚弱与主要结局显著相关（经CFS校正的优势比OR为2.51,95%可信区间CI为1.50-4.21；经mFI校正的优势比OR为2.60,95% CI为1.57-4.31）。TPR和FPR在不同器械间无显著差异。在多变量分析中，虚弱是死亡或新残疾的唯一显著预测因子。体弱多病个体的机构出院需求、费用和LOS显著增加。CFS更容易使用，需要的时间更少，丢失的数据也更少。结论：虚弱的老年人在手术后更有可能死亡或经历新的患者报告的残疾。临床医生在手术前进行虚弱评估时应考虑CFS而不是mFI，因为准确性相似，但易用性和可行性更高。
Objective: To compare the accuracy of the modified Fried Index (mFI) and the Clinical Frailty Scale (CFS) to predict death or patient-reported new disability 90 days after major elective surgery. Background: The association of frailty with patient-reported outcomes, and comparisons between preoperative frailty instruments are poorly described. Methods: This was a prospective multicenter cohort study. We determined frailty status in individuals >= 65 years having elective noncardiac surgery using the mFI and CFS. Outcomes included death or patient-reported new disability (primary); safety incidents, length of stay (LOS), and institutional discharge (secondary); ease of use, usefulness, benefit, clinical importance, and feasibility (tertiary). We measured the adjusted association of frailty with outcomes using regression analysis and compared true positive and false positive rates (TPR/FPR). Results: Of 702 participants, 645 had complete follow up. The CFS identified 297 (42.3%) with frailty, the mFI 257 (36.6%); 72 (11.1%) died or experienced a new disability. Frailty was significantly associated with the primary outcome (CFS adjusted odds ratio, OR, 2.51, 95% confidence interval, CI, 1.50-4.21; mFI adjusted-OR 2.60, 95% CI 1.57-4.31). TPR and FPR were not significantly different between instruments. Frailty was the only significant predictor of death or new disability in a multivariable analysis. Need for institutional discharge, costs and LOS were significantly increased in individuals with frailty. The CFS was easier to use, required less time and had less missing data. Conclusions: Older people with frailty are significantly more likely to die or experience a new patient-reported disability after surgery. Clinicians performing frailty assessments before surgery should consider the CFS over the mFI as accuracy was similar, but ease of use and feasibility were higher.