Ho P Michael, Masoudi Frederick A, Peterson Pamela N, Shroyer A Laurie, McCarthy Martin, Grover Frederick L, Hammermeister Karl E, Rumsfeld John S
Cardiology and Cardiovascular Outcomes Research, Denver VA Medical Center, Denver, CO 80220, USA.
Am J Geriatr Cardiol. 2005 Jul-Aug;14(4):176-82. doi: 10.1111/j.1076-7460.2005.04312.x.
The investigators assessed preoperative health-related quality of life as a predictor of 6-month mortality after cardiac surgery in older (65 years of age and older) vs. younger patients. Multivariable regression, stratified by age groups, was used to compare the association between preoperative Physical Component Summary and Mental Component Summary scores from the Short Form-36 health status survey and mortality. In multivariable analyses of older patients, lower preoperative Physical Component Summary (odds ratio, 1.54; 95% confidence interval, 1.19-2.00; p=0.01) and Mental Component Summary (odds ratio, 1.26; 95% confidence interval, 1.06-1.49; p=0.03) scores were independently associated with mortality. In contrast, neither Physical Component Summary (p=0.82) nor Mental Component Summary (p=0.79) scores were associated with mortality in the younger subgroup. This study demonstrated that preoperative health status is an independent predictor of mortality following cardiac surgery in older but not younger patients. Preoperative patient self-report of health status may be particularly useful in refining risk stratification and informing decision-making before and following cardiac surgery in older patients.
研究人员评估了术前健康相关生活质量，以此作为老年（65岁及以上）与年轻患者心脏手术后6个月死亡率的预测指标。采用按年龄组分层的多变量回归分析，比较简短健康调查量表36项的术前身体状况总结和精神状况总结评分与死亡率之间的关联。在老年患者的多变量分析中，术前较低的身体状况总结评分（比值比，1.54；95%置信区间，1.19 - 2.00；p = 0.01）和精神状况总结评分（比值比，1.26；95%置信区间，1.06 - 1.49；p = 0.03）与死亡率独立相关。相比之下，在年轻亚组中，身体状况总结评分（p = 0.82）和精神状况总结评分（p = 0.79）均与死亡率无关。这项研究表明，术前健康状况是老年而非年轻患者心脏手术后死亡率的独立预测指标。术前患者对健康状况的自我报告在优化老年患者心脏手术前后的风险分层及指导决策方面可能特别有用。
