Bekelis Kimon, Rahmani Redi, Kim-Hyung Joon, Calnan Daniel, MacKenzie Todd A
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
World Neurosurg. 2017 Mar;99:320-325. doi: 10.1016/j.wneu.2016.12.023. Epub 2016 Dec 18.
Despite the increasing number of elderly patients undergoing neurosurgical interventions, there are limited resources for preoperative assessment of frailty in this population. We investigated the association between recent history of falls and surgical outcomes for these patients.
We performed a prospective cohort study of all patients, 65 years and older, undergoing elective neurosurgical procedures from 2014-2015 in a tertiary referral medical center. We examined the association of sustaining a fall in the 6 months before the operation with discharge to a facility, readmissions, and complications in the first 30 days after discharge. In order to control for confounding, we used multivariable regression models and propensity score conditioning. Mixed-effects models were used to control for clustering at the surgeon level.
During the study period, 143 elderly patients underwent a neurosurgical procedure and met the inclusion criteria. Of these, 53.1% had a history of falls preoperatively. Mixed-effects multivariable logistic regression analysis demonstrated an association between preoperative falls and discharge to a facility (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.23-1.47), 30-day readmissions (OR, 1.57; 95% CI, 1.36-1.78), and 30-day complications (OR, 1.13; 95% CI, 1.03-1.23). Similar associations were present in propensity score-adjusted models and models stratified by cranial and spinal procedures.
History of at least 1 fall in the 6 months before a neurosurgical operation was associated with increased risk of discharge to a facility, readmissions, and complications in the first 30 days after discharge. History of prior falls should be taken into account during the preoperative risk assessment of neurosurgical patients.
尽管接受神经外科手术干预的老年患者数量不断增加，但针对该人群进行术前衰弱评估的资源有限。我们调查了这些患者近期跌倒史与手术结果之间的关联。
我们对2014年至2015年在一家三级转诊医疗中心接受择期神经外科手术的所有65岁及以上患者进行了一项前瞻性队列研究。我们研究了术前6个月内发生跌倒与出院后入住机构、再入院以及出院后前30天内并发症之间的关联。为了控制混杂因素，我们使用了多变量回归模型和倾向评分调整。混合效应模型用于控制外科医生层面的聚类情况。
在研究期间，143名老年患者接受了神经外科手术并符合纳入标准。其中，53.1%术前有跌倒史。混合效应多变量逻辑回归分析表明，术前跌倒与出院后入住机构（比值比[OR]，1.35；95%置信区间[CI]，1.23 - 1.47）、30天内再入院（OR，1.57；95% CI，1.36 - 1.78）以及30天内并发症（OR，1.13；95% CI，1.03 - 1.23）之间存在关联。在倾向评分调整模型以及按颅脑和脊柱手术分层的模型中也存在类似关联。
神经外科手术前6个月内至少有1次跌倒史与出院后入住机构、再入院以及出院后前30天内并发症风险增加相关。在对神经外科患者进行术前风险评估时应考虑既往跌倒史。
