Rege Rahul M, Runner Robert P, Staley Christopher A, Vu CatPhuong Cathy L, Arora Sona S, Schenker Mara L
Emory University, School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, United States.
Emory University, Department of Orthopaedics, 59 Executive Park South, Atlanta, GA 30329, United States.
Injury. 2018 Dec;49(12):2234-2238. doi: 10.1016/j.injury.2018.08.017. Epub 2018 Aug 22.
As morbidity and mortality from traumatic orthopaedic injuries continues to rise, increased research is being conducted on how to best predict complications in at risk patients. Recently, frailty indices have been validated in a variety of surgical subspecialties as predictors of morbidity and mortality. However, the vast majority of research has been conducted on geriatric patient populations, with little evidence on patients who are chronologically young. The purpose of this study was to evaluate the role of a modified frailty index (mFI) in predicting mortality and complications after pelvis, acetabulum, and lower extremity trauma in patients of all ages.
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2014 for all patients who underwent surgery for pelvis, acetabulum, and lower extremity trauma. The sample size was divided into geriatric (age ≥ 60) and young (age < 60) cohorts. The mFI score was calculated for each patient. Bivariate analysis was performed using logistic regression and a chi-square test to determine the relationship between mFI and both primary and secondary outcomes while adjusting for age. Univariate analysis and multivariate analyses were performed. All analyses were done using SAS 9.4 (Cary, NC) and a p < 0.05 was considered significant.
56,241 patients were identified to have undergone surgery for pelvis, acetabulum, or lower extremity trauma. 28% of patients were identified under the age of 60. In the young cohort, mFI was a strong predictor of thirty-day mortality (OR 11.02, 95% CI 6.26-19.39, p < 0.001). With regards to Clavien-Dindo grade IV complications, MFI is also a strong predictor in the young cohort (OR 28.82, 95% CI 16.05-51.77, p < 0.001).
The mFI score was a significant predictor of morbidity and mortality in chronologically young orthopaedic trauma patients. The use of the mFI score can provide an individualized risk assessment to interdisciplinary teams for perioperative counseling and to improve outcomes.
随着创伤性骨科损伤的发病率和死亡率持续上升，针对如何最佳预测高危患者并发症的研究日益增多。最近，衰弱指数已在多种外科亚专业中得到验证，可作为发病率和死亡率的预测指标。然而，绝大多数研究是针对老年患者群体进行的，关于年龄较小患者的证据很少。本研究的目的是评估改良衰弱指数（mFI）在预测各年龄段骨盆、髋臼和下肢创伤患者的死亡率及并发症方面的作用。
查询美国外科医师学会国家外科质量改进计划（NSQIP）数据库中2005年至2014年期间所有接受骨盆、髋臼和下肢创伤手术的患者。样本量分为老年（年龄≥60岁）和年轻（年龄<60岁）队列。计算每位患者的mFI评分。采用逻辑回归和卡方检验进行双变量分析，以确定mFI与主要和次要结局之间的关系，同时对年龄进行校正。进行单变量分析和多变量分析。所有分析均使用SAS 9.4（北卡罗来纳州卡里）软件，p<0.05被认为具有统计学意义。
共识别出56241例接受骨盆、髋臼或下肢创伤手术的患者。28%的患者年龄小于60岁。在年轻队列中，mFI是30天死亡率的有力预测指标（OR 11.02，95%CI 6.26 - 19.39，p<0.001）。关于Clavien-Dindo IV级并发症，MFI在年轻队列中也是一个有力的预测指标（OR 28.82，95%CI 16.05 - 51.77，p<0.001）。
mFI评分是年龄较小的骨科创伤患者发病率和死亡率的重要预测指标。使用mFI评分可为跨学科团队提供个性化的风险评估，用于围手术期咨询并改善预后。
