虚弱和较差的功能状态在动脉血管外科患者中很常见，并影响术后结果。

Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes.

机构信息

Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, 9th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Division of Health and Social Care Research, Kings College London, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK.

Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, 3rd Floor, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.

出版信息

Int J Surg. 2015 Jun;18:57-63. doi: 10.1016/j.ijsu.2015.04.037. Epub 2015 Apr 20.

DOI:10.1016/j.ijsu.2015.04.037

PMID:25907322

Abstract

OBJECTIVES

Increasing numbers of older people are undergoing emergency and elective arterial vascular procedures. Many older patients are frail which is a recognised predictor of adverse postoperative outcomes in other surgical specialties. This study in older patients undergoing arterial vascular surgery examined; the prevalence of preoperative frailty; the clinical feasibility of preoperatively measuring frailty and functional status; the association between these characteristics and adverse postoperative outcome.

METHODS

Prospective observational study in patients aged over 60 years undergoing elective and emergency arterial vascular surgery. Baseline measures of frailty (Edmonton Frail Scale), functional status (gait velocity, timed up and go, hand grip strength) and cognitive function (Montreal Cognitive Assessment) were obtained preoperatively. The primary outcome measure Length of Stay (LOS) and secondary outcome measures of postoperative morbidity (medical and surgical complications), functional status and postoperative in-hospital mortality were recorded.

RESULTS

125 patients were recruited. Frailty was common in this older surgical population (52% EFS score of ≥ 6.5) with high frailty scores observed (mean EFS 6.6, SD 3.05) and poor functional status (60% had TUG > 15 s, 45% had gait velocity of < 0.6 m/s). Higher preoperative EFS (> 6.5) was univariately associated with longer LOS (≥ 12 days), composite measures of postoperative infections, postoperative medical complications and adverse functional outcomes. EFS ≥ 6.5 was predictive of LOS ≥ 12 days, adjusted for age (AUC 0.660, CI 0.541-0.779, p = 0.010). This association between EFS ≥ 6.5 and LOS ≥ 12 days was strengthened with the addition of MoCA < 24 (AUC 0.695, CI 0.584-0.806, p = 0.002).

CONCLUSIONS

Patients aged over 60 years admitted for arterial vascular surgery were frail, had impaired functional status and were cognitively impaired. This combination of preoperative characteristics was predictive of longer hospital length of stay and associated with adverse postoperative outcome.

摘要

目的

越来越多的老年人接受急诊和择期动脉血管手术。许多老年人身体虚弱，这是其他外科专业不良术后结果的公认预测因素。本研究对接受动脉血管手术的老年患者进行了研究;术前虚弱的患病率;术前测量虚弱和功能状态的临床可行性;这些特征与不良术后结果之间的关系。

方法

对 60 岁以上接受择期和急诊动脉血管手术的患者进行前瞻性观察研究。术前获得虚弱（埃德蒙顿虚弱量表）、功能状态（步态速度、计时起立和行走、手握力）和认知功能（蒙特利尔认知评估）的基线测量值。主要结局测量指标为住院时间（LOS），次要结局测量指标为术后发病率（医疗和手术并发症）、功能状态和术后住院内死亡率。

结果

共招募 125 名患者。在这个老年手术人群中，虚弱很常见（52%的 EFS 评分≥6.5），虚弱评分较高（平均 EFS 为 6.6，SD 为 3.05），功能状态较差（60%的 TUG>15s，45%的步态速度<0.6m/s）。术前 EFS（>6.5）较高与 LOS（≥12 天）、术后感染、术后医疗并发症和不良功能结局的综合指标呈单变量相关。EFS≥6.5 与 LOS≥12 天相关，调整年龄后（AUC 0.660，CI 0.541-0.779，p=0.010）。EFS≥6.5 与 LOS≥12 天之间的这种关联在 MoCA<24 的情况下得到了加强（AUC 0.695，CI 0.584-0.806，p=0.002）。