Abdominal hysterectomy and high frailty score are associated with complications among older patients
Abdominal hysterectomy and high frailty score are associated with complications among older patients
复制标题
DOI：
10.1002/ijgo.14029
复制
发表时间：
2021-11-28
影响因子：
3.8
通讯作者：
Handa, Victoria L.
中科院分区：
文献类型：
--
作者：
Wainger, Julia J.;Yazdy, Golsa M.;Handa, Victoria L.
目的探讨体弱多病和子宫切除方式对老年子宫切除术患者术后30天发病率的影响。方法研究对象为2014年至2018年美国外科医师学会国家手术质量改进计划数据库中年龄在60岁及以上且接受单纯子宫切除术的患者。五因素修正虚弱指数（Five-Factor Modified虚弱Index）接近虚弱：女性得分在3分或以上，表明有更严重的合并症，被认为是虚弱的。采用带或不带交互项的Logistic回归多变量模型，研究虚弱和路径对术后并发症的独立和交互影响。结果19 888例子宫切除术中，腹式子宫切除术4356例（21.9%），腹腔镜子宫切除术13 382例（67%），阴道子宫切除术2150例（10.8%），体弱者251例（1.3%）。虚弱（优势比[OR] 1.89, 95%可信区间[CI] 1.32-2.70, P = 0.001）和腹部子宫切除术与腹腔镜子宫切除术（OR 2.14, 95% CI 1.88-2.45, P < 0.001）增加了并发症的发生率。评估相互作用，体弱患者腹部子宫切除术与腹腔镜子宫切除术的并发症发生率（OR 4.12, 95% CI 1.96-8.67, P < 0.001）高于非体弱患者（OR 2.10, 95% CI 1.84-2.40）。结论体弱多病的老年患者行子宫切除术并发症的风险增加，尤其是腹式子宫切除术与腹腔镜子宫切除术。虚弱指数可以作为术前指导咨询和路径选择的有用工具。
Objective To evaluate effects of frailty and hysterectomy route on 30-day postoperative morbidity for older hysterectomy patients. Methods Participants included patients in the American College of Surgeons' National Surgical Quality Improvement Program database aged 60 years or older and undergoing simple hysterectomy from 2014 to 2018. The Five-Factor Modified Frailty Index approximated frailty: women with scores of 3 or more, indicating more severe comorbidities, were considered frail. Logistic regression multivariable models with and without an interaction term were used to study the independent and interactive effects of frailty and route on postoperative complications. Results Of 19 888 hysterectomies, 4356 (21.9%) were abdominal, 13 382 (67%) were laparoscopic, and 2150 (10.8%) were vaginal, with 251 (1.3%) frail patients. Frailty (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.32-2.70, P = 0.001) and abdominal versus laparoscopic hysterectomy (OR 2.14, 95% CI 1.88-2.45, P < 0.001) increased complication odds. Assessing interaction, complication odds for abdominal versus laparoscopic hysterectomy were higher for frail patients (OR 4.12, 95% CI 1.96-8.67, P < 0.001) versus non-frail patients (OR 2.10, 95% CI 1.84-2.40). Conclusion Frail older patients have increased risk for hysterectomy complications, especially with abdominal hysterectomy versus laparoscopic hysterectomy. A frailty index can be a useful preoperative tool to guide counseling and route choice.