Preoperative frailty is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery
Preoperative frailty is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery
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DOI：
10.1007/s11748-019-01121-7
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发表时间：
2019-11-01
影响因子：
1.2
通讯作者：
Okamura, Homare
中科院分区：
文献类型：
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作者：
Arai, Yasuhiro;Kimura, Toru;Okamura, Homare
目的术前虚弱影响心血管手术后心脏康复（CR）进程。有不同的虚弱评估措施。然而，目前尚不清楚哪种工具最有可能预测CR的进展。我们的目的是使用不同的方法来评估术前虚弱，并确定术后CR进展的预测因素。方法2016年5月至2018年4月，89例患者在我院接受了择期心血管手术。死亡病例和未进行术前虚弱评估的患者被排除。本研究纳入了其余78例患者。我们将患者分为两组：47例患者在术后7天内实现100 m步行（成功CR组），31例患者在术后8天后实现100 m步行（延迟CR组）。使用Kaigo-Yobo检查表、心血管健康研究、简短体能测试和临床虚弱量表评估术前虚弱程度。结果延迟完全缓解组的四项指标所定义的虚弱患病率较高。延迟CR组的营养状况、血清血红蛋白水平、血清白蛋白水平和腰大肌指数较低。多变量分析表明，Kaigo-Yobo检查表评分是延迟CR的独立预测因素（比值比1.53，95%置信区间1.18 - 1.98，p = 0.001），临床虚弱量表是出院到医疗机构的独立预测因素（比值比3.70，95%置信区间1.30 - 10.51，p = 0.014）。结论在评估虚弱的各种工具中，Kaigo Yobo检查表最有可能预测择期心血管手术后CR的进展。
Objective Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR. Methods Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100 m walking within 7 days after surgery (successful CR group) and 31 patients who achieved 100 m walking later than 8 days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale. Results The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18-1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30-10.51, p = 0.014). Conclusions Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.