Components of Geriatric Assessments Predict Thoracic Surgery Outcomes
Components of Geriatric Assessments Predict Thoracic Surgery Outcomes
复制标题
DOI：
10.1016/j.jss.2010.05.050
复制
发表时间：
2011-03-01
影响因子：
2.2
通讯作者：
Weigel, Tracey
中科院分区：
文献类型：
--
作者：
Kothari, Anai;Phillips, Sarah;Weigel, Tracey
背景资料。目前还没有工具可以让外科医生客观地量化老年患者的手术风险。我们的前瞻性研究的目标是确定从常见老年综合征的有效筛查中提取的个别问题是否对老年胸部肿瘤患者的手术风险具有预测价值。70岁的患者被招募参加一项前瞻性的、IRB批准的研究，该研究涉及术前实施有效的筛查试验。采用老年抑郁量表(GDS)、营养筛查主动性营养健康量表(NSI NHC)、简易精神状态检查(MMSE)、简明疲劳量表(BFI)、日常生活活动能力(ADLS)和工具性日常生活活动能力(IADLS)评定。所有纳入本研究的患者均计划接受胸部手术。在IADL“购物”中有依赖的患者比那些没有依赖的患者更有可能出现重大并发症并出院到非家庭地点(P=0.011，0.003)。与回答“否”的患者相比，对NSI NHC的问题1、9和10回答“是”的患者平均住院时间更长(P=0.039、0.010、0.031)。对GDS问题2回答“是”与主要并发症的发生率相关(r=0.270，P=0.037)。对GDS第12个问题回答“是”会增加术后出院到非家庭场所的可能性(优势比=11.64，95%可信区间0.68-202.86，P=0.047)。我们的数据表明，使用先前验证的筛查工具中的个别问题，可以开发一种简短、快速的术前评估，以评估患有胸部恶性肿瘤的老年患者的手术风险、住院时间和出院目的地。(C)2011 Elsevier Inc.保留所有权利。
Background. No tool currently exists to rapidly allow surgeons to objectively quantify surgical risk in geriatric patients. The goal of our prospective study was to determine if individual questions extracted from validated screens for common geriatric syndromes would have predictive value for surgical risk in geriatric patients with thoracic neoplasms.Methods. Patients >= 70 y old were recruited to participate in a prospective, IRB-approved study involving the preoperative administration of validated screening tests. Patients were given the geriatric depression scale (GDS), nutrition screening initiative nutritional health checklist (NSI NHC), mini mental status exam (MMSE), brief fatigue inventory (BFI), and assessed for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). All patients enrolled in this study were scheduled for thoracic surgery.Results. Patients who responded to having a dependency in the IADL "shopping" were more likely to have major complications and to be discharged to a non-home location than those without a dependency (P = 0.011, 0.003). Patients who answered "yes" to questions 1, 9, and 10 of the NSI NHC had a longer mean length of stay compared with patients who answered "no" (P = 0.039, 0.010, 0.031). Answering "yes" to GDS question 2 correlated with the incidence of major complications (r = 0.270 P = 0.037). Answering "yes" to GDS question 12 increased the likelihood of being discharged to a non-home location postoperatively (odds ratio = 11.64, 95% CI, 0.68-202.86, P = 0.047).Conclusions. Our data indicate that an abbreviated, rapid presurgical assessment can be developed for estimating operative risk, length of stay, and discharge destination in geriatric patients with thoracic malignancies using individual questions from previously validated screening tools. (C) 2011 Elsevier Inc. All rights reserved.