Department of General Surgery, Henry Ford Hospital, Detroit, Michigan.
Department of Thoracic Surgery, Henry Ford Hospital, Detroit, Michigan.
Ann Thorac Surg. 2013 Oct;96(4):1240-1245. doi: 10.1016/j.athoracsur.2013.05.051. Epub 2013 Jul 31.
Esophagectomy is associated with significant morbidity and mortality. This retrospective study examined use of a modified frailty index as a potential predictor of morbidity and mortality in esophagectomy patients.
National Surgical Quality Improvement Program Participant Use Files were reviewed for 2005 through 2010. Patients undergoing esophagectomy were selected based on CPT codes. A modified frailty index with 11 variables was used to determine correlation between frailty and postesophagectomy morbidity and mortality. Data were analyzed using χ(2) test and logistic regression.
A total of 2,095 patients were included in the analysis. Higher frailty scores were associated with a statistically significant increase in morbidity and mortality. A frailty score of 0, 1, 2, 3, 4, and 5 had associated morbidity rates of 17.9% (142 of 795 patients), 25.1% (178 of 710 patients), 31.4% (126 of 401 patients), 34.4% (48 of 140 patients), 44.4% (16 of 36 patients), and 61.5% (8 of 13 patients), respectively. A frailty score of 0, 1, 2, 3, 4, and 5 had associated mortality rates of 1.8% (14 of 795 patients), 3.8% (27 of 710 patients), 4% (16 of 401 patients), 7.1% (10 of 140 patients), 8.3% (3 of 36 patients), and 23.1% (3 of 13 patients), respectively. When using multivariate logistic regression for mortality comparing age, functional status, prealbumin, emergency surgery, wound class, American Society of Anesthesiologists score, and sex, only age and frailty were statistically significant. The odds ratio was 31.84 for frailty (p = 0.015) and 1.05 (p = 0.001) for age.
Using a large national database, a modified frailty index was shown to correlate with postesophagectomy morbidity and mortality. Such an index may be used to aid in improving risk assessment and patient selection for esophagectomy.
食管切除术与显著的发病率和死亡率相关。本回顾性研究检查了改良衰弱指数作为食管切除术患者发病率和死亡率的潜在预测指标的应用。
审查了 2005 年至 2010 年全国手术质量改进计划参与者使用文件。根据 CPT 代码选择接受食管切除术的患者。使用包含 11 个变量的改良衰弱指数来确定衰弱与术后发病率和死亡率之间的相关性。使用卡方检验和逻辑回归进行数据分析。
共纳入 2095 例患者进行分析。较高的衰弱评分与发病率和死亡率的统计学显著增加相关。衰弱评分为 0、1、2、3、4 和 5 的患者的发病率分别为 17.9%（795 例中的 142 例）、25.1%（710 例中的 178 例）、31.4%（401 例中的 126 例）、34.4%（140 例中的 48 例）、44.4%（36 例中的 16 例）和 61.5%（13 例中的 8 例）。衰弱评分为 0、1、2、3、4 和 5 的患者的死亡率分别为 1.8%（795 例中的 14 例）、3.8%（710 例中的 27 例）、4%（401 例中的 16 例）、7.1%（140 例中的 10 例）、8.3%（36 例中的 3 例）和 23.1%（13 例中的 3 例）。在使用多变量逻辑回归比较死亡率时，考虑了年龄、功能状态、前白蛋白、急诊手术、伤口分级、美国麻醉师协会评分和性别，只有年龄和衰弱具有统计学意义。衰弱的优势比为 31.84（p=0.015），年龄的优势比为 1.05（p=0.001）。
使用大型国家数据库，显示改良衰弱指数与食管切除术后发病率和死亡率相关。这样的指数可以用于帮助改善食管切除术的风险评估和患者选择。
