FRCSC, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Room 2006, Halifax, NS B3H 3A7, Canada.
Circulation. 2010 Mar 2;121(8):973-8. doi: 10.1161/CIRCULATIONAHA.108.841437. Epub 2010 Feb 16.
Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. Where elderly patients are increasingly referred for cardiac surgery, the prevalence of a frail group among these is also on the rise. We assessed frailty as a risk factor for adverse outcomes after cardiac surgery.
Functional measures of frailty and clinical data were collected prospectively for all cardiac surgery patients at a single center. Frailty was defined as any impairment in activities of daily living (Katz index), ambulation, or a documented history of dementia. Of 3826 patients, 157 (4.1%) were frail. Frail patients were older, were more likely to be female, and had risk factors for adverse surgical outcomes. By logistic regression, frailty was an independent predictor of in-hospital mortality (odds ratio 1.8, 95% CI 1.1 to 3.0), as well as institutional discharge (odds ratio 6.3, 95% CI 4.2 to 9.4). Frailty was an independent predictor of reduced midterm survival (hazard ratio 1.5, 95% CI 1.1 to 2.2).
Frailty is a risk for postoperative complications and an independent predictor of in-hospital mortality, institutional discharge, and reduced midterm survival. Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care.
衰弱是医学领域的一个新兴概念，尚未被探索为心脏手术的风险因素。随着越来越多的老年患者被推荐接受心脏手术，这类患者中衰弱群体的比例也在上升。我们评估了衰弱作为心脏手术后不良结局的一个风险因素。
在一个中心对所有心脏手术患者前瞻性地收集了衰弱的功能测量和临床数据。衰弱定义为日常生活活动（Katz 指数）、行走能力或记录的痴呆病史受损。在 3826 名患者中，有 157 名（4.1%）衰弱。衰弱患者年龄较大，更可能为女性，且有不良手术结局的风险因素。通过逻辑回归，衰弱是院内死亡率（比值比 1.8，95%置信区间 1.1 至 3.0）以及机构出院（比值比 6.3，95%置信区间 4.2 至 9.4）的独立预测因子。衰弱是中期生存率降低的独立预测因子（风险比 1.5，95%置信区间 1.1 至 2.2）。
衰弱是术后并发症的危险因素，也是院内死亡率、机构出院和中期生存率降低的独立预测因子。衰弱筛查可改善心脏手术患者的风险评估，并可能确定一个可能受益于创新护理流程的患者亚组。
