Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery
Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery
复制标题
DOI：
10.1161/circulationaha.108.841437
复制
发表时间：
2010-03-02
期刊：
影响因子：
37.8
通讯作者：
Hirsch, Gregory M.
中科院分区：
文献类型：
--
作者：
Lee, Dana H.;Buth, Karen J.;Hirsch, Gregory M.
背景——虚弱是医学中的一个新兴概念，尚未作为心脏手术的危险因素进行探索。随着越来越多的老年患者转诊接受心脏手术，其中体弱人群的患病率也在上升。我们将虚弱评估为心脏手术后不良后果的危险因素。方法和结果——前瞻性地收集单个中心所有心脏手术患者的虚弱功能测量和临床数据。虚弱被定义为日常生活活动（卡茨指数）、行走能力或有记录的痴呆病史的任何损害。在 3826 名患者中，157 名（4.1%）身体虚弱。体弱的患者年龄较大，更有可能是女性，并且存在不良手术结果的危险因素。通过逻辑回归，虚弱是院内死亡率（比值比 1.8，95% CI 1.1 至 3.0）以及出院（比值比 6.3，95% CI 4.2 至 9.4）的独立预测因素。虚弱是中期生存率降低的独立预测因素（风险比 1.5，95% CI 1.1 至 2.2）。结论：虚弱是术后并发症的风险，也是院内死亡率、机构出院和中期生存率降低的独立预测因素。衰弱筛查可改善心脏手术患者的风险评估，并可能识别出可能受益于创新护理流程的患者亚组。 （流通。2010 年；121：973-978。）
Background-Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. Where elderly patients are increasingly referred for cardiac surgery, the prevalence of a frail group among these is also on the rise. We assessed frailty as a risk factor for adverse outcomes after cardiac surgery.Methods and Results-Functional measures of frailty and clinical data were collected prospectively for all cardiac surgery patients at a single center. Frailty was defined as any impairment in activities of daily living (Katz index), ambulation, or a documented history of dementia. Of 3826 patients, 157 (4.1%) were frail. Frail patients were older, were more likely to be female, and had risk factors for adverse surgical outcomes. By logistic regression, frailty was an independent predictor of in-hospital mortality (odds ratio 1.8, 95% CI 1.1 to 3.0), as well as institutional discharge (odds ratio 6.3, 95% CI 4.2 to 9.4). Frailty was an independent predictor of reduced midterm survival (hazard ratio 1.5, 95% CI 1.1 to 2.2).Conclusions-Frailty is a risk for postoperative complications and an independent predictor of in-hospital mortality, institutional discharge, and reduced midterm survival. Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care. (Circulation. 2010; 121: 973-978.)