Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery.
Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery.
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DOI：
10.1111/jgs.14387
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发表时间：
2016-12
影响因子：
6.3
通讯作者：
Marcantonio ER
中科院分区：
文献类型：
--
作者：
Cooper Z;Rogers SO Jr;Ngo L;Guess J;Schmitt E;Jones RN;Ayres DK;Walston JD;Gill TM;Gleason LJ;Inouye SK;Marcantonio ER
手术前的脆弱与骨科手术后不良的术后结果有关；然而，在这一人群中，脆弱的衡量标准还没有被比较。我们在大型择期骨科手术前应用脆弱表型(FP)和脆弱指数(FI)对脆弱状态进行分类，并评估与术后结果的相关性。前瞻性队列研究。马萨诸塞州波士顿的两家三级医院。415名接受定期骨科手术的70岁≥患者参加了SAGS：选择性手术后成功老龄化(SAGS)研究。术前评估包括使用FP和FI评估脆弱程度。我们使用加权kappa统计来确定两种脆弱测量和多变量模型之间的一致性，以确定每种测量与术后并发症、术后住院时间(LOS)和5天、出院到急性后(PAC)机构护理和30天再入院之间的关系。虚弱非常普遍(FP占35%，FI占41%)。FP和FI具有中等一致性(kappa=0.42，95%可信区间(CI)0.36，0.49)。当使用FP时，与健壮组相比，早衰组发生并发症的风险较高(RR 1.6，95%CI 1.1，2.1)和PAC(RR 1.8，95%CI 1.2，2.9)，易预测并发症(RR 1.7，95%CI 1.1，2.1)，LOS>；5天(RR 3.1，95%CI 1.1，8.8)和PAC(RR 2.3 95%CI 1.4，3.7)。使用FI预测LOS>；5天(RR 2.1，95%CI 1.0，4.8)和PAC(RR 1.5，95%CI 1.4，2.1)与脆弱(RR=1.9，95%CI 1.4，2.5；RR 3.1，95%CI 1.4，6.8)。其他结果与虚弱状态没有显著关联。FP和FI均可预测大型择期骨科手术后的预后，应考虑进行术前风险分层。
Preoperative frailty has been associated with poor postoperative outcomes after orthopedic surgery; however frailty measures have not been compared in this population. We applied the Frailty Phenotype (FP) and Frailty Index (FI) before major elective orthopedic surgery to categorize frailty status and assessed association with postoperative outcomes. Prospective cohort study. Two tertiary hospitals in Boston, MA. 415 patients aged ≥70 years undergoing scheduled orthopedic surgery enrolled in SAGES: Successful Aging after Elective Surgery (SAGES) Study. Preoperative evaluation included assessment of frailty using the FP and FI. We used the weighted kappa statistic to determine concordance between the 2 frailty measures and multivariable modeling to determine associations between each measure and postoperative complications, postoperative length of stay (LOS) >5 days, discharge to post acute (PAC) institutional care, and 30 day readmission. Frailty was highly prevalent (FP 35%, FI 41%). There was moderate concordance between the FP and FI (kappa=.42, 95% confidence interval (CI) .36,.49). When using FP, compared to the robust group, being pre-frail predicted higher risk of complications (RR 1.6, 95% CI 1.1,2.1) and PAC (RR 1.8, 95% CI 1.2,2.9);being frail predicted complications (RR 1.7, 95% CI 1.1,2.1), LOS >5 days (RR 3.1, 95% CI 1.1,8.8), and PAC(RR 2.3 95% CI 1.4,3.7). When using FI, being pre-frail predicted LOS > 5 days (RR 2.1, 95% CI 1.0,4.8), and PAC (RR 1.5, 95% CI 1.4,2.1) as did being frail (RR=1.9, 95% CI 1.4,2.5; and RR 3.1, 95% CI 1.4,6.8 respectively).. The other outcomes were not significantly associated with frailty status. Both FP and FI predict postoperative outcomes after major elective orthopedic surgery, and should be considered for preoperative risk stratification.
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DOI：
10.1111/j.1532-5415.2007.01413.x
发表时间：
2007-11-01
影响因子：
6.3
作者：
Hardy, Susan E.;Perera, Subashan;Studenski, Stephanie A.
通讯作者：
Studenski, Stephanie A.
影响因子：
5.7
作者：
Leung JM;Tsai TL;Sands LP
通讯作者：
Sands LP
影响因子：
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作者：
Gregersen, Merete;Morch, Marianne Metz;Damsgaard, Else Marie
通讯作者：
Damsgaard, Else Marie
DOI：
10.1093/gerona/61.3.262
发表时间：
2006-03-01
影响因子：
5.1
作者：
Bandeen-Roche, K;Xue, QL;Fried, LP
通讯作者：
Fried, LP
影响因子：
7.2
作者：
RICHARDSON, MT;LEON, AS;SERFASS, R
通讯作者：
SERFASS, R