McIsaac Daniel I, Taljaard Monica, Bryson Gregory L, Beaule Paul E, Gagne Sylvain, Hamilton Gavin, Hladkowicz Emily, Huang Allen, Joanisse John, Lavallée Luke T, Moloo Hussein, Thavorn Kednapa, van Walraven Carl, Yang Homer, Forster Alan J
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.
Ottawa Hospital Research Institute, Ottawa, Canada.
BMC Anesthesiol. 2016 Nov 14;16(1):111. doi: 10.1186/s12871-016-0276-0.
BACKGROUND: Frailty is an aggregate expression of susceptibility to poor outcomes, owing to age-, and disease-related deficits that accumulate within multiple domains. Older patients who are frail before surgery are at an increased risk of morbidity and mortality, and use a disproportionately high amount of healthcare resources. While frailty is now a well-established risk factor for adverse postoperative outcomes, the perioperative literature lacks studies that: 1) compare the predictive accuracy of different frailty instruments; 2) consider the impact of frailty on patient-reported outcome measures; and 3) consider the acceptability and feasibility of using frailty instruments in clinical practice. METHODS: We will conduct a multicenter prospective cohort study comparing the predictive accuracy of the modified Fried Index (mFI) with the Clinical Frailty Scale (CFS) among consenting patients aged 65 years and older having elective major non-cardiac surgery. The primary outcome will be disability free survival at 90 days after surgery, a patient-reported outcome measure. Secondary outcomes will include complications, length of stay, discharge disposition, readmission and total health system costs. We will compare the accuracy of frailty instruments using the relative true positive rate and relative false positive rate. These measures can be interpreted as the relative difference in the probability of one instrument identifying a true case of death or new disability compared to another instrument, or the relative difference in the probability of one instrument identifying a false case of death or new disability, respectively. We will also assess the acceptability and feasibility of each instrument. DISCUSSION: Frailty is an important prognostic factor in the growing population of older patients having surgery. This study will provide novel findings regarding the choice of an accurate, clinically useable frailty instrument in predicting patient reported outcomes, as well as morbidity, mortality and resource use. These findings will inform current practice and future research.
背景：衰弱是由于年龄和疾病相关的多领域累积缺陷导致易发生不良后果的一种综合表现。术前衰弱的老年患者发生并发症和死亡的风险增加，且使用的医疗资源不成比例地高。虽然衰弱现在是术后不良结局的一个公认风险因素，但围手术期文献缺乏以下研究：1）比较不同衰弱评估工具的预测准确性；2）考虑衰弱对患者报告结局指标的影响；3）考虑在临床实践中使用衰弱评估工具的可接受性和可行性。 方法：我们将开展一项多中心前瞻性队列研究，比较改良弗里德指数（mFI）与临床衰弱量表（CFS）在年龄≥65岁且接受择期非心脏大手术的同意患者中的预测准确性。主要结局将是术后90天无残疾生存，这是一个患者报告结局指标。次要结局将包括并发症、住院时间、出院处置、再入院和卫生系统总费用。我们将使用相对真阳性率和相对假阳性率比较衰弱评估工具的准确性。这些指标可分别解释为一种工具识别真正死亡或新残疾病例的概率与另一种工具相比的相对差异，或一种工具识别假死亡或新残疾病例的概率的相对差异。我们还将评估每种工具的可接受性和可行性。 讨论：在日益增多的接受手术的老年患者中，衰弱是一个重要的预后因素。本研究将提供关于选择一种准确、临床可用的衰弱评估工具以预测患者报告结局以及并发症、死亡率和资源使用情况的新发现。这些发现将为当前实践和未来研究提供参考。
Anesth Analg. 2021-8-1
J Am Coll Surg. 2010-4-28
J Am Med Dir Assoc. 2017-8-31
Curr Opin Anaesthesiol. 2020-12
Age Ageing. 2015-3-29
Anesthesiology. 2015-3
Can J Anaesth. 2015-2
Zotero 插件