Rodrigues Miguel K, Marques Artur, Lobo Denise M L, Umeda Iracema I K, Oliveira Mayron F
Hospital Sírio Libanês, São Paulo, SP, Brazil.
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2017 Oct;109(4):299-306. doi: 10.5935/abc.20170131. Epub 2017 Sep 4.
Frailty is identified as a major predictor of adverse outcomes in older surgical patients. However, the outcomes in pre-frail patients after cardiovascular surgery remain unknown.
To investigate the main outcomes (length of stay, mechanical ventilation time, stroke and in-hospital death) in pre-frail patients in comparison with no-frail patients after cardiovascular surgery.
221 patients over 65 years old, with established diagnosis of myocardial infarction or valve disease were enrolled. Patients were evaluated by Clinical Frailty Score (CFS) before surgery and allocated into 2 groups: no-frailty (CFS 1~3) vs. pre-frailty (CFS 4) and followed up for main outcomes. For all analysis, the statistical significance was set at 5% (p < 0.05).
No differences were found in anthropometric and demographic data between groups (p > 0.05). Pre-frail patients showed a longer mechanical ventilation time (193 ± 37 vs. 29 ± 7 hours; p<0.05) than no-frail patients; similar results were observed for length of stay at the intensive care unit (5 ± 1 vs. 3 ± 1 days; p < 0.05) and total time of hospitalization (12 ± 5 vs. 9 ± 3 days; p < 0.05). In addition, the pre-frail group had a higher number of adverse events (stroke 8.3% vs. 3.9%; in-hospital death 21.5% vs. 7.8%; p < 0.05) with an increased risk for development stroke (OR: 2.139, 95% CI: 0.622-7.351, p = 0.001; HR: 2.763, 95%CI: 1.206-6.331, p = 0.0001) and in-hospital death (OR: 1.809, 95% CI: 1.286-2.546, p = 0.001; HR: 1.830, 95% CI: 1.476-2.269, p = 0.0001). Moreover, higher number of pre-frail patients required homecare services than no-frail patients (46.5% vs. 0%; p < 0.05).
Patients with pre-frailty showed longer mechanical ventilation time and hospital stay with an increased risk for cardiovascular events compared with no-frail patients.
衰弱被认为是老年外科手术患者不良结局的主要预测因素。然而，心血管手术后衰弱前期患者的结局仍不清楚。
研究心血管手术后衰弱前期患者与非衰弱患者的主要结局（住院时间、机械通气时间、中风和院内死亡）。
纳入221例65岁以上确诊为心肌梗死或瓣膜病的患者。术前通过临床衰弱评分（CFS）对患者进行评估，并分为两组：非衰弱组（CFS 1~3）与衰弱前期组（CFS 4），并对主要结局进行随访。所有分析中，统计学显著性设定为5%（p<0.05）。
两组间人体测量和人口统计学数据无差异（p>0.05）。衰弱前期患者的机械通气时间长于非衰弱患者（193±37 vs. 29±7小时；p<0.05）；在重症监护病房的住院时间（5±1 vs. 3±1天；p<0.05）和总住院时间（12±5 vs. 9±3天；p<0.05）也观察到类似结果。此外，衰弱前期组的不良事件数量更多（中风8.3% vs. 3.9%；院内死亡21.5% vs. 7.8%；p<0.05），中风发生风险增加（OR：2.139，95%CI：0.622-7.351，p=0.001；HR：2.763，95%CI：1.206-6.331，p=0.0001），院内死亡风险增加（OR：1.809，95%CI：1.286-2.546，p=0.001；HR：1.830，95%CI：1.476-2.269，p=0.0001）。此外，与非衰弱患者相比，衰弱前期患者需要家庭护理服务的人数更多（46.5% vs. 0%；p<0.05）。
与非衰弱患者相比，衰弱前期患者的机械通气时间和住院时间更长，心血管事件风险增加。
