简化衰弱指数预测根治性膀胱切除术预后。

A Simplified Frailty Index to Predict Outcomes After Radical Cystectomy.

机构信息

Department of Urology, University of Minnesota, Minneapolis, MN, USA; Department of Surgery, Urology Unit, and Olivia Newton-John Cancer Research Institute, University of Melbourne, Austin Health, Melbourne, Australia.

Department of Urology, University of Minnesota, Minneapolis, MN, USA.

出版信息

Eur Urol Focus. 2019 Jul;5(4):658-663. doi: 10.1016/j.euf.2017.12.011. Epub 2018 Jan 20.

DOI:10.1016/j.euf.2017.12.011

PMID:29366857

Abstract

BACKGROUND

Traditional surgical risk indices are notoriously inaccurate, especially for the elderly, so there has been a trend to evaluate frailty instead.

OBJECTIVE

To describe a simplified five-item frailty index for evaluating radical cystectomy outcomes and compare its predictive ability with other risk assessment tools for a total patient cohort and a subgroup of patients aged ≥65yr.

DESIGN, SETTING, AND PARTICIPANTS: The National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2015 was queried for radical cystectomy cases for bladder cancer. A simplified five-item frailty index (sFI) was created based on previously described measures of frailty.

OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS

Correlation of the sFI with postoperative outcomes was investigated using multivariate logistic regression analyses. The predictive ability of the sFI was compared to the extended 11-item frailty index, NSQIP risk calculator, and the American Society of Anesthesiologists (ASA) score by comparing the area under the receiver operating characteristic curve. Subgroup analysis was performed for those aged ≥65 yr to evaluate the accuracy of the index in the older age group, for which traditional risk indices are notoriously inaccurate.

RESULTS AND LIMITATIONS

Of 5516 cases identified, 10.7% experienced a Clavien grade ≥3 complication within 30 d of surgery. Individuals with an sFI of 3+ had a greater likelihood of experiencing a major complication (odds ratio 3.22, 95% confidence interval 2.01-5.17). The sFI outperformed the ASA score in predicting major complications and had a similar predictive ability to the more complex 11-item index and NSQIP risk calculator. There was also a significant correlation between the sFI and discharge destination. These relationships were consistent in the subgroup of patients aged ≥65yr. The study is limited by the database, which only records 30-d outcomes and does not allow evaluation of long-term sequelae.

CONCLUSIONS

There is a strong correlation between frailty assessed via the sFI and radical cystectomy outcomes, including in the elderly. This tool can be used in the clinical setting to counsel patients and aid decision-making.

PATIENT SUMMARY

This study demonstrated that a simple five-item frailty index can be used to assess preoperative risk in patients undergoing radical cystectomy.

摘要

背景

传统的手术风险指数准确性较差，尤其是对于老年人，因此评估虚弱已成为一种趋势。

目的

描述一种简化的五因素衰弱指数，用于评估根治性膀胱切除术的结果，并将其预测能力与总患者队列和≥65 岁亚组的其他风险评估工具进行比较。

设计、地点和参与者：从 2007 年至 2015 年，国家外科质量改进计划（NSQIP）数据库对膀胱癌根治性膀胱切除术病例进行了查询。基于先前描述的虚弱衡量标准，创建了简化的五因素衰弱指数（sFI）。

结局测量和统计分析

使用多变量逻辑回归分析研究 sFI 与术后结局的相关性。通过比较接受者操作特征曲线下的面积，将 sFI 的预测能力与扩展的 11 项衰弱指数、NSQIP 风险计算器和美国麻醉医师协会（ASA）评分进行比较。对于≥65 岁的患者进行亚组分析，以评估该指数在老年患者中的准确性，因为传统的风险指数在老年患者中准确性较差。

结果和局限性

在确定的 5516 例病例中，有 10.7%的患者在术后 30 天内出现 Clavien 分级≥3 级的并发症。sFI 为 3+的个体发生重大并发症的可能性更大（比值比 3.22，95%置信区间 2.01-5.17）。sFI 在预测主要并发症方面优于 ASA 评分，并且与更复杂的 11 项指数和 NSQIP 风险计算器具有相似的预测能力。sFI 与出院去向之间也存在显著相关性。这些关系在≥65 岁的患者亚组中也是一致的。该研究的局限性在于该数据库仅记录 30 天的结果，无法评估长期后果。