累积虚弱特征可预测老年患者术后出院至医疗机构。
Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient.
机构信息
Department of Surgery, University of Colorado at Denver School of Medicine, Aurora, CO 80045, USA.
出版信息
J Am Coll Surg. 2011 Jul;213(1):37-42; discussion 42-4. doi: 10.1016/j.jamcollsurg.2011.01.056. Epub 2011 Mar 23.
BACKGROUND
Frailty is a state of increased vulnerability to health-related stressors and can be measured by summing the number of frailty characteristics present in an individual. Discharge institutionalization (rather than discharge to home) represents disease burden and functional dependence after hospitalization. Our aim was to determine the relationship between frailty and need for postoperative discharge institutionalization.
STUDY DESIGN
Subjects ≥ 65 years undergoing major elective operations requiring postoperative ICU admission were enrolled. Discharge institutionalization was defined as need for institutionalized care at hospital discharge. Fourteen preoperative frailty characteristics were measured in 6 domains: comorbidity burden, function, nutrition, cognition, geriatric syndromes, and extrinsic frailty.
RESULTS
A total of 223 subjects (mean age 73 ± 6 years) were studied. Discharge institutionalization occurred in 30% (n = 66). Frailty characteristics related to need for postoperative discharge institutionalization included: older age, Charlson index ≥ 3, hematocrit <35%, any functional dependence, up-and-go ≥ 15 seconds, albumin <3.4 mg/dL, Mini-Cog score ≤ 3, and having fallen within 6 months (p < 0.0001 for all comparisons). Multivariate logistic regression retained prolonged timed up-and-go (p < 0.0001) and any functional dependence (p < 0.0001) as the variables most closely related to need for discharge institutionalization. An increased number of frailty characteristics present in any one subject resulted in increased rate of discharge institutionalization.
CONCLUSIONS
Nearly 1 in 3 geriatric patients required discharge to an institutional care facility after major surgery. The frailty characteristics of prolonged up-and-go and any functional dependence were most closely related to the need for discharge institutionalization. Accumulation of a higher number of frailty characteristics in any one geriatric patient increased their risk of discharge institutionalization.
背景
衰弱是一种对健康相关压力源易感性增加的状态，可以通过将个体存在的衰弱特征数量相加来衡量。出院后入住医疗机构（而不是回家）代表住院后疾病负担和功能依赖。我们的目的是确定衰弱与术后出院入住医疗机构需求之间的关系。
研究设计
纳入≥ 65 岁、接受需要术后 ICU 入住的主要择期手术的患者。出院入住医疗机构定义为出院时需要机构护理。在 6 个领域中测量了 14 项术前衰弱特征：合并症负担、功能、营养、认知、老年综合征和外在衰弱。
结果
共纳入 223 名患者（平均年龄 73 ± 6 岁）。30%（n = 66）发生术后出院入住医疗机构需求。与术后出院入住医疗机构需求相关的衰弱特征包括：年龄较大、Charlson 指数≥ 3、血细胞比容<35%、任何功能依赖、起立行走测试≥ 15 秒、白蛋白<3.4mg/dL、Mini-Cog 评分≤ 3、6 个月内跌倒（所有比较均 p<0.0001）。多变量逻辑回归保留了较长的起立行走测试（p<0.0001）和任何功能依赖（p<0.0001），作为与出院入住医疗机构需求最密切相关的变量。任何一位患者存在的衰弱特征数量增加，导致其出院入住医疗机构的比例增加。
结论
近 1/3 的老年患者在接受大手术后需要入住医疗机构。起立行走测试时间延长和任何功能依赖的衰弱特征与出院入住医疗机构的需求最为密切相关。任何一位老年患者的衰弱特征数量增加，其出院入住医疗机构的风险增加。
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