Modified frailty index is predictive of wound complications in obese patients undergoing gynecologic surgery via a midline vertical incision
Modified frailty index is predictive of wound complications in obese patients undergoing gynecologic surgery via a midline vertical incision
复制标题
DOI：
10.1016/j.ygyno.2019.11.008
复制
发表时间：
2020-04-01
影响因子：
4.7
通讯作者：
Thaker, Premal H.
中科院分区：
文献类型：
--
作者：
Mullen, Mary M.;Porcelli, Bree P.;Thaker, Premal H.
目的：有有限的方法来确定哪些肥胖患者在接受妇科手术后会出现伤口并发症。我们试图确定虚弱和术后伤口并发症之间的关系，并建立一个预测模型，为伤口并发症在这一患者population.Methods：我们回顾了前瞻性收集的数据，肥胖患者接受剖腹手术，通过中线垂直切口从7/2013-3/2016。使用先前验证的11种合并症计算改良虚弱指数（MFI）。主要结局是术后伤口并发症的复合发生率。使用Fisher精确检验或卡方检验和t检验或Kruskal-Wallis检验分析数据。Poisson回归模型用于生成相对风险。预测模型建立与receiver-operator characteristic curve analysis.Results：纳入的163例患者中，56例（34%）被认为是虚弱的。52例患者（31.9%）发生伤口并发症：28例（50%）体弱患者和24例（22.4%）非体弱患者（RR 2.23，95%CI 1.29-3.85）。虚弱患者的伤口破裂频率显著更高（37.5% vs 15%，RR 2.51，95%CI 1.31-4.81）。在控制BMI、吸烟和术后最高血糖后，虚弱仍然是伤口并发症的独立预测因素（aRR 1.88，95%CI 1.04-3.40）。合并虚弱的预测模型的曲线下面积为0.73伤口complications.Conclusion：虚弱与伤口并发症在肥胖患者接受妇科手术通过中线垂直切口，是一个有用的工具，在确定最高风险的患者。需要进一步的前瞻性研究将MFI纳入术前计划和咨询。(C)2019爱思唯尔公司All rights reserved.
Objectives: There are limited methods to identify which obese patients will experience wound complications after undergoing gynecologic surgery. We sought to determine the association between frailty and postoperative wound complications and to develop a prediction model for wound complications in this patient population.Methods: We reviewed prospectively collected data of obese patients undergoing laparotomy though midline vertical incisions from 7/2013-3/2016. Modified frailty index (mFI) was calculated using 11 comorbidities previously validated. The primary outcome was the composite rate of postoperative wound complication. Data was analyzed using Fisher exact test or Chi-square and t-tests or Kruskal-Wallis tests. Poisson regression models were used to generate relative risks. Prediction models were created with receiver-operator characteristic curve analysis.Results: Of 163 patients included, 56 (34%) were considered frail. Wound complications occurred in 52 patients (31.9%): 28 (50%) frail and 24 (22.4%) non-frail patients (RR 2.23, 95%CI 1.29-3.85). Frail patients had significantly greater frequencies of wound breakdown (37.5% vs 15%, RR 2.51, 95%CI 1.31-4.81). After controlling for BMI, tobacco use, and maximum postoperative glucose, frailty remained an independent predictor of wound complication (aRR 1.88, 95%CI 1.04-3.40). The area under the curve for the predictive model incorporating frailty was 0.73 for wound complications.Conclusion: Frailty is associated with wound complications in obese patients undergoing gynecologic surgery via a midline vertical incision and is a useful tool in identifying the most high risk patients. Further prospective research is necessary to incorporate mFI into preoperative planning and counseling. (C) 2019 Elsevier Inc. All rights reserved.