Esses Gary, Andreopoulos Evie, Lin Hung-Mo, Arya Shipra, Deiner Stacie
From the Departments of Anesthesiology.
Population Health Science and Policy and Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Anesth Analg. 2018 Jan;126(1):39-45. doi: 10.1213/ANE.0000000000002411.
Aortic valve replacement is a high-risk surgery (3%-5%, 30-day mortality) performed on approximately 30,000 elderly patients a year in the United States. Currently, preoperative risk assessment is based on a composite of medical examination and a subjective evaluation for frailty ("eyeball test"). Objective frailty assessment using validated indices has the potential to improve risk stratification. The purpose of this study was to (1) establish whether frailty can predict 30-day mortality and composite morbidity in patients undergoing aortic valve replacement and (2) compare the predictive ability of 3 frailty indices in this population.
This study was a retrospective cohort study of 3088 patients 65 years old and older undergoing aortic valve replacement surgery (based on current procedure terminology codes) between the years 2006 and 2012 extracted from the American College of Surgeons National Surgical Quality Improvement Program database. Frailty was assessed using the modified frailty index, risk analysis index, and Ganapathi indices. Outcomes measured were 30-day mortality and composite morbidity (myocardial infarction, cardiac arrest, pulmonary embolism, pneumonia, reintubation, renal insufficiency, coma >24 hours, urinary tract infections, sepsis, deep vein thrombosis, deep wound surgical site infection, superficial site infection, and reoperation).
Frailty was a better predictor of mortality than morbidity, and it was not markedly different among any of the 3 indices. Frailty was associated with an increased risk of 30-day mortality and longer lengths of stay.
Frailty can predict mortality in patients undergoing aortic valve replacement. Choice of frailty index does not make a difference in this patient population.
主动脉瓣置换术是一项高风险手术（30天死亡率为3%-5%），在美国每年约有30000名老年患者接受该手术。目前，术前风险评估基于体格检查和对虚弱的主观评估（“肉眼观察法”）。使用经过验证的指标进行客观的虚弱评估有可能改善风险分层。本研究的目的是：（1）确定虚弱是否能预测接受主动脉瓣置换术患者的30天死亡率和综合发病率；（2）比较3种虚弱指数在该人群中的预测能力。
本研究是一项回顾性队列研究，从美国外科医师学会国家外科质量改进计划数据库中提取了2006年至2012年间3088例65岁及以上接受主动脉瓣置换手术（基于当前手术术语编码）的患者。使用改良虚弱指数、风险分析指数和加纳帕蒂指数评估虚弱情况。测量的结果为30天死亡率和综合发病率（心肌梗死、心脏骤停、肺栓塞、肺炎、再次插管、肾功能不全、昏迷>24小时、尿路感染、败血症、深静脉血栓形成、深部手术部位感染、浅表部位感染和再次手术）。
虚弱对死亡率的预测比发病率更好，并且在这3种指数中任何一种之间没有明显差异。虚弱与30天死亡率增加和住院时间延长相关。
虚弱可以预测接受主动脉瓣置换术患者的死亡率。在该患者群体中，虚弱指数的选择没有差异。
