Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, People's Republic of China.
Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
Gynecol Oncol. 2019 Apr;153(1):68-73. doi: 10.1016/j.ygyno.2018.12.025. Epub 2019 Jan 3.
We sought to examine the relationship between frailty and complicated postoperative courses, including intensive care unit (ICU) admission and non-home discharge, in patients with advanced ovarian cancer (OC) undergoing primary debulking surgery (PDS) for curative intent.
Patients were identified from a retrospectively collected database at a single institution between 1/1/2003-12/31/2011. A frailty index was derived from 30 items representing comorbidities and activities of daily living, each scored as 0, 0.5, or 1, and calculated as the total summated score divided by the total number of non-missing items. Frailty was defined as an index ≥0.15. Associations with binary outcomes were assessed using logistic regression.
A total of 535 patients met inclusion criteria. Frail patients were older, mean age 67.8 versus 63.2 years (p < 0.001), but there was no difference in grade, stage, or serous histology. Almost half of the frail patients (48.9%, 64/131) were admitted to the ICU compared to 20.5% (83/404) of non-frail patients. Frailty remained an independent predictor of 30-day ICU admission (adjusted odds ratio (aOR) 3.20, 95% CI: 2.03-5.06) in a multivariable model including age, preoperative albumin, surgical complexity, and residual disease. Frail patients were also more likely to have a non-home discharge (24.2% vs. 7.0%). Frailty independently predicted non-home discharge (aOR 2.58, 95% CI: 1.35-4.93) after adjusting for age, BMI, and stage.
Frailty is a measurable, objective clinical syndrome that has impact on postoperative outcomes in advanced OC and should be considered when decision-making about treatments and counseling patients.
我们旨在研究虚弱与复杂术后情况（包括入住重症监护病房（ICU）和非出院回家）之间的关系，这些复杂术后情况发生于接受旨在治愈的初始肿瘤细胞减灭术（PDS）的晚期卵巢癌（OC）患者中。
患者信息从一家单机构的回顾性数据库中获得，时间为 2003 年 1 月 1 日至 2011 年 12 月 31 日。通过 30 项代表合并症和日常生活活动的项目计算衰弱指数，每项评分 0、0.5 或 1，计算方法为总求和分数除以非缺失项目的总数。衰弱指数≥0.15 定义为衰弱。使用逻辑回归评估二项结果的相关性。
共有 535 名患者符合纳入标准。虚弱患者年龄较大，平均年龄 67.8 岁比 63.2 岁（p<0.001），但分级、分期或浆液性组织学无差异。近一半的虚弱患者（48.9%，64/131）入住 ICU，而非虚弱患者为 20.5%（83/404）。在包括年龄、术前白蛋白、手术复杂性和残留疾病的多变量模型中，虚弱仍然是 30 天 ICU 入住的独立预测因素（调整后优势比（aOR）3.20，95%CI：2.03-5.06）。虚弱患者也更有可能非出院回家（24.2%比 7.0%）。虚弱独立预测非出院回家（调整后 aOR 2.58，95%CI：1.35-4.93），调整年龄、BMI 和分期。
虚弱是一种可测量的、客观的临床综合征，对晚期 OC 的术后结果有影响，在制定治疗决策和为患者提供咨询时应考虑这一因素。
