Andreou Alexandros, Lasithiotakis Konstantinos, Venianaki Maria, Xenaki Sofia, Chlouverakis Grigorios, Petrakis Ioannis, Chalkiadakis Georgios
Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
, York, UK.
World J Surg. 2018 Dec;42(12):3897-3902. doi: 10.1007/s00268-018-4734-3.
Frailty in a surgical geriatric population may identify patients at increased risk of complications. However, the optimal method to diagnose it remains to be identified. This study aims to compare two common frailty models and assess their association with postoperative adverse outcomes in elderly patients undergoing general surgical procedures.
Prospective study including 298 patients age 65 years or older undergoing elective general surgical operations in a tertiary hospital. Frailty phenotype (FP) was classified using a validated scale which included weight loss, weakness, exhaustion, slowed walking speed and low physical activity. A preoperative comprehensive geriatric assessment (CGA) was performed including managing daily activities (ADL), instrumental ADL, cognitive status, comorbidities, polypharmacy and nutritional status. Main outcomes measures were postoperative complications and length of stay.
There were 135 (46%), 114 (38%) and 46 (15%) minor/intermediate, major and major + procedures, respectively. The agreement between the FP and CGA was moderate (kappa index: 0.45). FP was significantly associated with postoperative complications with an odds ratio (OR) of 2.3, (95% confidence interval 1.4-3.8, p < 0.01). The association of CGA with postoperative complications did not reach statistical significance (p = 0.07). Postoperative hospital stay was significantly longer in both CGA frailty (p < 0.001) and FP (p = 0.001) groups compared to the fit population. In the multivariate analysis adjusted for ASA and POSSUM category, FP retained its significance as a predictor of postoperative complications (OR: 1.9, 95% CI 1.03-3.3, p = 0.038).
FP was associated more consistently than CGA with adverse postoperative outcomes in elderly patients undergoing general surgical procedures.
外科老年人群中的衰弱可能提示患者并发症风险增加。然而，诊断衰弱的最佳方法仍有待确定。本研究旨在比较两种常见的衰弱模型，并评估它们与接受普通外科手术的老年患者术后不良结局的相关性。
前瞻性研究纳入了一家三级医院中298例年龄在65岁及以上接受择期普通外科手术的患者。使用经过验证的量表对衰弱表型（FP）进行分类，该量表包括体重减轻、虚弱、疲劳、步行速度减慢和体力活动减少。术前进行了全面的老年综合评估（CGA），包括日常生活活动能力（ADL）、工具性ADL、认知状态、合并症、多重用药和营养状况。主要结局指标为术后并发症和住院时间。
分别有135例（46%）、114例（38%）和46例（15%）进行了小/中型、大型和大型+手术。FP和CGA之间的一致性为中等（kappa指数：0.45）。FP与术后并发症显著相关，比值比（OR）为2.3（95%置信区间1.4 - 3.8，p < 0.01）。CGA与术后并发症的相关性未达到统计学意义（p = 0.07）。与健康人群相比，CGA衰弱组（p < 0.001）和FP组（p = 0.001）的术后住院时间均显著延长。在根据美国麻醉医师协会（ASA）和手术预后和手术严重性评分系统（POSSUM）类别进行调整的多变量分析中，FP作为术后并发症的预测指标仍具有显著性（OR：1.9，95% CI 1.03 - 3.3，p = 0.038）。
在接受普通外科手术的老年患者中，与CGA相比，FP与术后不良结局的相关性更为一致。
