Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study
Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study
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DOI：
10.1093/ageing/afy217
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发表时间：
2019-05-01
期刊：
影响因子：
6.7
通讯作者：
Myint, P. K.
中科院分区：
文献类型：
--
作者：
Hewitt, J.;Carter, B.;Myint, P. K.
背景：任何年龄组的体弱患者都比不体弱的患者更容易死亡。我们的目的是评估虚弱对所有年龄的急诊外科患者的临床死亡率、再入院率和住院时间的影响。方法采用多中心前瞻性队列研究对急性外科住院的成人进行研究。每个作为外科急诊就诊的患者，无论他们最终是否接受了外科手术，都被包括在内。该研究于2015年至2016年进行。虚弱的定义采用7分临床虚弱量表。主要终点是第90天的死亡率。次要结局包括：第30天的死亡率、住院时间和第30天内的再入院率。结果该队列纳入2279例患者（中位年龄54岁[IQR 36-72]， 56%为女性）。所有年龄段的患者都有虚弱的记录：40岁以下的患者占1%，80岁以上的患者占45%。我们发现，虚弱程度每加重一步，第90天死亡率增加80% (OR 1.80, 95% CI: 1.61-2.01)，支持线性剂量-反应关系。此外，最虚弱的患者住院时间越来越长，30天内再次入院，30天内死亡的可能性越来越大。结论：任何年龄虚弱程度的恶化都与患者预后明显较差相关，包括未经选择的急性外科住院患者的死亡率。虚弱的评估应纳入急诊外科实践，以允许预后和实施策略，以改善结果。
Background frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.Methods a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016. Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.Results the cohort included 2,279 patients (median age 54 years [IQR 36-72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40's to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61-2.01) supporting a linear dose-response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.Conclusions worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.