Comparison of Surgeon Assessment to Frailty Measurement in Abdominal Aortic Aneurysm Repair.
Comparison of Surgeon Assessment to Frailty Measurement in Abdominal Aortic Aneurysm Repair.
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DOI：
10.1016/j.jss.2019.11.005
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发表时间：
2020-04
期刊：
影响因子：
--
通讯作者：
Arya S
中科院分区：
文献类型：
--
作者：
George EL;Kashikar A;Rothenberg KA;Barreto NB;Chen R;Trickey AW;Arya S
腹主动脉瘤腔内修复术（EVAR）使我们能够对其他被认为不适合开放式修复术的患者进行干预。尽管其在确定手术入路中的重要性，但尚未对腹主动脉瘤腔内修复术患者的主观“眼球测试”和术前虚弱的客观测量进行比较。在血管质量倡议（VQI）数据库[2003-2017]中识别了接受择期腹主动脉瘤腔内修复术的患者。根据外科医生报告的变量，将患者归类为“不适合”。使用VQI衍生的风险分析指数（VQI-RAI）定义虚弱，该指数包括性别、年龄、BMI、肾衰竭、充血性心力衰竭、呼吸困难、术前Amplitude和功能状态。健康和/或虚弱与不良结局之间的关联通过logistic回归确定。共纳入11，694例接受择期腹主动脉瘤腔内修复术的患者，其中仅18.1%“不适合”，34.6%“虚弱”，总体43.6%“不适合或虚弱”。被认为“不健康”或“虚弱”的患者死亡率、并发症和非家庭出院的几率显著增加（p<0.001），虚弱和不健康对这些结果的阴性预测值均大于93%。在校正的logistic回归中，增加客观虚弱显著改善了预测非家庭出院（C-统计量0.65 vs 0.71，p <0.001）和并发症（0.59 vs 0.61，p=0.01）的模型性能，但预测死亡率相似（0.74 vs 0.73，p=0.99）。术前虚弱评估提供了一个有用的危险分层的客观措施，作为医生的临床直觉的辅助。虚弱的增加扩大了高风险患者的范围，这些患者更有可能在选择性腹主动脉瘤腔内修复术后经历不良术后事件，并且可能从独特定制的围手术期干预中受益。
Endovascular abdominal aortic aneurysm repair (EVAR) allows us to intervene on patients otherwise considered poor candidates for open repair. Despite its importance in determining operative approach, no comparison has been made between the subjective “eyeball test” and an objective measurement of preoperative frailty for EVAR patients. Patients undergoing elective EVAR were identified in the Vascular Quality Initiative (VQI) database [2003-2017]. Patients were classified “unfit” based on a surgeon-reported variable. Frailty was defined using the VQI-derived Risk Analysis Index (VQI-RAI) which includes sex, age, BMI, renal failure, congestive heart failure, dyspnea, preoperative ambulation and functional status. The association between fitness and/or frailty and adverse outcomes was determined by logistic regression. A total of 11,694 patients undergoing elective EVAR were included of which only 18.1% were “unfit” while 34.6% were “frail”, and overall 43.6% “unfit or frail.” Patients deemed “unfit” or “frail” had significantly increased odds of mortality, complications, and non-home discharge (p<0.001), and both frailty and unfitness generated negative predictive values for these outcomes greater than 93%. In adjusted logistic regression, the addition of objective frailty significantly improved model performance in predicting non-home discharge (C-statistic 0.65 vs 0.71, p <0.001) and complications (0.59 vs 0.61, p=0.01), but similarly predicted mortality (0.74 vs 0.73, p=0.99). Preoperative frailty assessment provides a useful objective measure of risk stratification as an adjunct to a physician’s clinical intuition. The addition of frailty expands the pool of high-risk patients who are more likely to experience adverse postoperative events following elective EVAR and may benefit from uniquely tailored perioperative interventions.
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影响因子：
120.7
作者：
KRUSE, JA;THILLBAHAROZIAN, MC;CARLSON, RW
通讯作者：
CARLSON, RW
影响因子：
4.3
作者：
Arya, Shipra;Kim, Sung In;Dodson, Thomas F.
通讯作者：
Dodson, Thomas F.
DOI：
10.1161/circoutcomes.113.000329
发表时间：
2014-01-01
影响因子：
6.9
作者：
Jain, Renuka;Duval, Sue;Adabag, Selcuk
通讯作者：
Adabag, Selcuk
脆弱共识：行动呼吁。
DOI：
10.1016/j.jamda.2013.03.022
发表时间：
2013-06
影响因子：
7.6
作者：
Morley JE;Vellas B;van Kan GA;Anker SD;Bauer JM;Bernabei R;Cesari M;Chumlea WC;Doehner W;Evans J;Fried LP;Guralnik JM;Katz PR;Malmstrom TK;McCarter RJ;Gutierrez Robledo LM;Rockwood K;von Haehling S;Vandewoude MF;Walston J
通讯作者：
Walston J
影响因子：
1.9
作者：
DELONG, ER;DELONG, DM;CLARKEPEARSON, DI
通讯作者：
CLARKEPEARSON, DI