Division of Population Medicine, Cardiff University, Cardiff, UK.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Age Ageing. 2019 May 1;48(3):388-394. doi: 10.1093/ageing/afy217.
frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.
a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.
the cohort included 2,279 patients (median age 54 years [IQR 36-72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40's to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61-2.01) supporting a linear dose-response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.
worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.
任何年龄段的虚弱患者的死亡率都高于非虚弱患者。我们旨在评估虚弱对所有年龄段急诊手术患者的临床死亡率、再入院率和住院时间的影响。
对急性外科病房的成年住院患者进行了一项多中心前瞻性队列研究。纳入了所有二级护理就诊的外科急症患者，无论最终是否接受了手术。该研究于 2015 年至 2016 年进行。使用 7 分临床虚弱量表定义虚弱。主要结局是 90 天死亡率。次要结局包括：30 天死亡率、住院时间和 30 天内再入院率。
该队列包括 2279 名患者（中位年龄 54 岁[IQR 36-72]；56%为女性）。所有年龄段的患者均记录了虚弱情况：40 岁以下患者为 1%，80 岁以上患者为 45%。我们发现，虚弱程度每增加一级，90 天死亡率就会增加 80%（OR 1.80，95%CI：1.61-2.01），支持线性剂量反应关系。此外，最虚弱的患者住院时间更长、30 天内再入院和 30 天内死亡的可能性更大。
任何年龄段的虚弱程度恶化都与患者预后显著恶化相关，包括未选择的急性外科住院患者的死亡率。虚弱评估应纳入急诊外科实践，以进行预后评估和实施改善预后的策略。
