Nieman Carrie L, Pitman Karen T, Tufaro Anthony P, Eisele David W, Frick Kevin D, Gourin Christine G
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Maryland, U.S.A.
The Johns Hopkins Center on Aging and Health, Johns Hopkins Medical Institutions, Maryland, U.S.A.
Laryngoscope. 2018 Jan;128(1):102-110. doi: 10.1002/lary.26735. Epub 2017 Jul 21.
To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery.
Cross-sectional analysis.
Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator.
Frailty was identified in 7.4% of patients and was significantly associated with advanced comorbidity (odds ratio [OR] = 1.5[1.3-1.8]), Medicaid (OR = 1.5[1.3-1.8]), major procedures (OR = 1.6[1.4-1.8]), flap reconstruction (OR = 1.7[1.3-2.1]), high-volume hospitals (OR = 0.7[0.5-1.0]), discharge to a short-term facility (OR = 4.4[2.9-6.7]), or other facility (OR = 5.4[4.5-6.6]). Frailty was a significant predictor of in-hospital death (OR = 1.6[1.1-2.4]), postoperative surgical complications (OR = 2.0[1.7-2.3]), acute medical complications (OR = 3.9[3.2-4.9]), increased LOS (mean, 4.9 days), and increased mean incremental costs ($11,839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail.
Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail.
2c. Laryngoscope, 128:102-110, 2018.
确定衰弱与合并症、住院死亡率、术后并发症、住院时间（LOS）以及头颈癌（HNCA）手术费用之间的关系。
横断面分析。
使用交叉表和多变量回归模型分析了2001年至2010年期间全国住院患者样本中159301例因口腔恶性肿瘤、喉癌、下咽癌或口咽癌接受消融手术患者的出院数据。根据约翰霍普金斯调整临床组衰弱定义诊断指标中的衰弱定义诊断集群来定义衰弱。
7.4%的患者被确定为衰弱，且与晚期合并症（优势比[OR]=1.5[1.3 - 1.8]）、医疗补助（OR = 1.5[1.3 - 1.8]）、大手术（OR = 1.6[1.4 - 1.8]）、皮瓣重建（OR = 1.7[1.3 - 2.1]）、大容量医院（OR = 0.7[0.5 - 1.]]）、转至短期护理机构（OR = 4.4[2.9 - 6.7]）或其他机构（OR = 5.4[4.5 - 6.6]）显著相关。衰弱是住院死亡（OR = 1.6[1.1 - 2.4]）、术后手术并发症（OR = 2.0[1.7 - 2.3]）、急性医疗并发症（OR = 3.9[3.2 - 4.9]）、住院时间增加（平均4.9天）以及平均增量成本增加（11839美元）的显著预测因素，并且与手术并发症几率增加和成本增加相关，比晚期合并症更甚。在急性医疗并发症和住院时间方面，衰弱与合并症之间存在显著交互作用，对合并症且衰弱患者的医疗并发症几率和住院时间具有协同效应。
衰弱是HNCA手术患者术后发病率、死亡率、住院时间和费用的独立预测因素，并且与合并症存在协同交互作用，这与合并症且衰弱患者发生医疗并发症可能性增加和住院时间延长相关。
2c。《喉镜》，128:102 - 110，2018年。
