Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
J Hepatobiliary Pancreat Sci. 2018 Aug;25(8):377-387. doi: 10.1002/jhbp.568. Epub 2018 Jul 23.
Age-related events, such as cardiopulmonary complications, delirium, transfer to a rehabilitation facility, and dependency are a major problem after hepatic resection in the elderly. This prospective multicenter study aimed to preoperatively evaluate frailty in the elderly according to a phenotypic frail index, named the "Kihon Checklist (KCL)," to predict "age-related events" after hepatic resection.
Between May 2016 and September 2017, 217 independently living patients who consented among all patients aged ≥65 years who planned to undergo hepatic resection were included in the study. Preoperative frailty was defined as a total KCL score ≥8. We analyzed clinical characteristics and outcomes, including age-related events (major respiratory and cardiac complications, delirium medication needed, transfer to rehabilitation facility, and dependency) between patients with and without frailty.
Of the 217 patients, 63 and 154 were classified into the frail and non-frail groups, respectively. The incidences of age-related events (31.7% vs. 7.8%, P < 0.001) were higher in the frail group. Multivariate analysis indicated that frailty (P < 0.001, hazard ratio 5.16) and resection of ≥2 sectors (P = 0.014, hazard ratio 2.98) were independent risk factors for age-related events.
Frailty evaluated by KCL in the elderly can predict postoperative age-related events after hepatic resection.
与年龄相关的事件，如心肺并发症、谵妄、转至康复设施和依赖，是老年人肝切除术后的主要问题。本前瞻性多中心研究旨在根据表型虚弱指数（命名为“健康检查清单（KCL）”）对老年人进行术前虚弱评估，以预测肝切除术后的“与年龄相关的事件”。
2016 年 5 月至 2017 年 9 月，共纳入 217 名独立生活并同意接受肝切除术的 65 岁以上患者，将术前虚弱定义为 KCL 总分≥8。分析了两组患者的临床特征和结局，包括有无虚弱的患者之间与年龄相关的事件（主要呼吸和心脏并发症、需要使用镇静剂、转至康复设施和依赖）。
217 名患者中，63 名和 154 名患者分别分为虚弱组和非虚弱组。虚弱组与年龄相关的事件发生率（31.7%比 7.8%，P<0.001）更高。多因素分析表明，虚弱（P<0.001，风险比 5.16）和切除≥2 个肝段（P=0.014，风险比 2.98）是与年龄相关的事件的独立危险因素。
KCL 评估的老年人虚弱可以预测肝切除术后与年龄相关的事件。
