Endicott Kendal M, Emerson Dominic, Amdur Richard, Macsata Robyn
Division of Vascular Surgery, Washington DC Veteran's Affairs Medical Center, Washington, D.C.
Division of Vascular Surgery, Washington DC Veteran's Affairs Medical Center, Washington, D.C..
J Vasc Surg. 2017 Jan;65(1):40-45. doi: 10.1016/j.jvs.2016.05.079. Epub 2016 Jul 25.
Functional status is a simple and rapidly assessable metric that may be used as a predictor for surgical outcomes. This study examined the association of functional status with short-term mortality after abdominal aortic aneurysm (AAA) repair in octogenarians to characterize the utility of functional status as a means of preoperative risk assessment.
All patients who underwent endovascular and open AAA repair from 2002 to 2010 within the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database were identified. Functional status, defined as an ordinal scale from 1 to 3 (1, independent; 2, partially dependent; 3, totally dependent), was examined using multivariate regression models with 30-day mortality as the primary outcome. For the purpose of analysis, this 3-point scale was converted into a binomial scale of function, with "normal" including 1 (completely independent) and "abnormal" including 2 or 3 (partially to totally dependent).
We identified 9030 patients who underwent AAA repair (46.6% open and 53.4% endovascular). Mortality at 30 days was 2.8% for the entire cohort (4.2% open, 1.7% endovascular; P < .001). There were 1340 patients aged ≥80 years, of which 67.3% underwent endovascular AAA repair. Among all age groups, functional status was a significant predictor of 30-day mortality (<80 years, P < .001; ≥80 years, P < .001). The ≥80 cohort with abnormal function status also demonstrated increased operative mortality (P = .002), length of stay (P = .001), and incidence of pulmonary complications (P = .025) compared with the cohort with normal functional status. Multivariate logistic regression demonstrated that within the ≥80-year-old cohort, only functional status remained a significant predictor of mortality (P < .001). In addition, the strength of the association between functional status and mortality was greater in the older cohort than in the younger one (Cox regression hazard ratio: 3.13 vs 2.18).
Functional status is a simple and rapidly applicable predictor of mortality within AAA patients and may be a useful tool to help preoperatively risk-stratify elderly patients presenting with AAA in need of repair. Further studies are needed to understand how best to apply these data to the clinical setting to guide preoperative decision making.
功能状态是一种简单且可快速评估的指标，可作为手术结果的预测指标。本研究探讨了功能状态与八旬老人腹主动脉瘤（AAA）修复术后短期死亡率之间的关联，以确定功能状态作为术前风险评估手段的效用。
在退伍军人事务部外科质量改进计划（VASQIP）数据库中，识别出2002年至2010年间接受血管内和开放性AAA修复的所有患者。功能状态定义为1至3的有序量表（1，独立；2，部分依赖；3，完全依赖），使用以30天死亡率为主要结局的多变量回归模型进行研究。为了分析目的，将这个3分制量表转换为功能的二项式量表，“正常”包括1（完全独立），“异常”包括2或3（部分至完全依赖）。
我们识别出9030例接受AAA修复手术的患者（46.6%为开放性手术，53.4%为血管内手术）。整个队列的30天死亡率为2.8%（开放性手术为4.2%，血管内手术为1.7%；P <.001）。年龄≥80岁的患者有1340例，其中67.3%接受了血管内AAA修复。在所有年龄组中，功能状态是30天死亡率的显著预测指标（<80岁，P <.001；≥80岁，P <.001）。与功能状态正常的队列相比，功能状态异常的≥80岁队列的手术死亡率（P =.002）更高，住院时间（P =.001）更长，肺部并发症发生率（P =.025）更高。多变量逻辑回归显示，在≥80岁的队列中，只有功能状态仍然是死亡率的显著预测指标（P <.001）。此外，功能状态与死亡率之间的关联强度在老年队列中比在年轻队列中更大（Cox回归风险比：3.13对2.18）。
功能状态是AAA患者死亡率的一个简单且快速适用的预测指标，可能是帮助对需要修复的AAA老年患者进行术前风险分层的有用工具。需要进一步研究以了解如何最好地将这些数据应用于临床环境，以指导术前决策。
