Preoperative frailty assessment predicts loss of independence after vascular surgery
Preoperative frailty assessment predicts loss of independence after vascular surgery
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DOI：
10.1016/j.jvs.2018.02.044
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发表时间：
2018-11-01
影响因子：
4.3
通讯作者：
Brooke, Benjamin S.
中科院分区：
文献类型：
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作者：
Donald, Graham W.;Ghaffarian, Amir A.;Brooke, Benjamin S.
目的：虚弱是一种与代谢储备丧失相关的临床综合征，在到血管外科诊所进行评估的患者中很普遍。临床虚弱量表（CFS）是一种快速评估方法，对识别虚弱患者具有高度特异性。在这项研究中，我们试图评估术前CFS评分是否可用于预测大血管手术后的独立性丧失。方法：我们确定了2015年12月至2017年12月期间在学术医疗中心接受择期大血管手术（入院>24小时）之前使用CFS前瞻性评估的所有在家独立生活的患者。患者和手术水平的临床数据来自我们的机构血管质量倡议登记数据库。使用双变量和多变量回归模型评估出院到非家庭地点或30天死亡率的复合结局。共有134名独立患者在接受择期开放式腹主动脉瘤修复术（8%）、动脉瘤腔内修复术（26%）、胸主动脉腔内修复术（6%）、腹股沟上旁路术（6%）、腹股沟下旁路术（16%）、颈动脉内膜切除术（19%）或外周血管介入术（20%）。在39例（29%）使用CFS分类为虚弱的患者中，与非虚弱患者相比，年龄或美国麻醉医师协会的身体状况无显著差异。然而，虚弱的患者在手术后更可能需要移动辅助（62%虚弱vs 22%非虚弱; P
Objective: Frailty, a clinical syndrome associated with loss of metabolic reserves, is prevalent among patients who present to vascular surgery clinics for evaluation. The Clinical Frailty Scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures.Methods: We identified all patients living independently at home who were prospectively assessed using the CFS before undergoing an elective major vascular surgery procedure (admitted for >24 hours) at an academic medical center between December 2015 and December 2017. Patient-and procedure-level clinical data were obtained from our institutional Vascular Quality Initiative registry database. The composite outcome of discharge to a nonhome location or 30-day mortality was evaluated using bivariate and multivariate regression models.Results: A total of 134 independent patients were assessed using the CFS before they underwent elective open abdominal aortic aneurysm repair (8%), endovascular aneurysm repair (26%), thoracic endovascular aortic repair (6%), suprainguinal bypass (6%), infrainguinal bypass (16%), carotid endarterectomy (19%), or peripheral vascular intervention (20%). Among 39 (29%) individuals categorized as being frail using the CFS, there was no significant difference in age or American Society of Anesthesiologists physical status compared with nonfrail patients. However, frail patients were significantly more likely to need mobility assistance after surgery (62% frail vs 22% nonfrail; P