Marshall Lachlan, Griffin Rayleene, Mundy Julie
Department of Cardiothoracic Surgery, Princess Alexandra Hospital Woolloongabba, Queensland, Australia
Department of Cardiothoracic Surgery, Princess Alexandra Hospital Woolloongabba, Queensland, Australia.
Asian Cardiovasc Thorac Ann. 2016 Jul;24(6):546-54. doi: 10.1177/0218492316653557.
Frailty has been used to predict outcome in gerontology but has only recently been applied to measures of perioperative risk stratification. It provides information on physiological reserve not addressed by current scoring systems which are heavily reliant on age.
We enrolled 123 patients over 70-years old (mean age 77.1 years, 69% male) undergoing open cardiac surgery, and assessed in 11 different frailty measures. These were combined into a cumulative score that was stratified into robust (49%), borderline (37%), and frail (14%) groups. The groups were compared for a short-term composite measure comprising mortality, deep sternal wound infection, inter-facility discharge or prolonged length of stay, as well as 3-month mortality and quality of life and 6-month mortality.
Frail patients had a considerably higher incidence of an unfavorable composite outcome (52.9%) compared to their borderline (28.3%) and robust (13.3%) counterparts (p = 0.003). Hospital mortality was 4/123 (3.3%) with a further 3 within 30 days, and 2 late deaths occurred within 6 months postoperatively. This was statistically significant with greater mortality at 6 months in the frail cohort. Quality of life at 3 months showed a trend towards greater improvement in the borderline patients compared to either the robust or frail groups.
Frailty status impacts on both short- and intermediate-term outcomes, including postoperative quality of life. In an ageing population where nonmaleficence and resource allocation are increasingly important, individual assessment in marginal surgical candidates may provide additional information to both the patient and clinician.
衰弱已被用于预测老年医学中的预后，但直到最近才应用于围手术期风险分层的评估。它提供了当前评分系统未涉及的生理储备信息，而当前评分系统严重依赖年龄。
我们纳入了123例70岁以上（平均年龄77.1岁，69%为男性）接受心脏直视手术的患者，并对11种不同的衰弱评估指标进行了评估。这些指标被合并为一个累积评分，并分为强壮组（49%）、临界组（37%）和衰弱组（14%）。比较了这三组在包括死亡率、深部胸骨伤口感染、转院或住院时间延长的短期综合指标，以及3个月死亡率、生活质量和6个月死亡率方面的情况。
与临界组（28.3%）和强壮组（13.3%）相比，衰弱患者出现不良综合结局的发生率（52.9%）要高得多（p = 0.003）。医院死亡率为4/123（3.3%），30天内又有3例死亡，术后6个月内发生2例晚期死亡。在衰弱队列中，6个月时死亡率更高，具有统计学意义。3个月时的生活质量显示，临界组患者相比强壮组或衰弱组有更大改善的趋势。
衰弱状态对短期和中期结局均有影响，包括术后生活质量。在一个非伤害性和资源分配日益重要的老龄化人群中，对边缘手术候选者进行个体评估可能会为患者和临床医生提供额外信息。
