Division of General and GI Surgery, Department of Surgery, School of Medicine, Emory University, 1365 Clifton Road, 4th Floor Building A, Atlanta, GA, 30322, USA.
, Portland, USA.
Hernia. 2019 Oct;23(5):891-898. doi: 10.1007/s10029-019-01923-x. Epub 2019 Mar 6.
Frailty is a decrease in physiologic reserve that is separate from the normal aging process. Previously, an 11-item modified frailty index (mFI) using NSQIP variables predicted outcomes for surgical patients. We aim to validate a condensed 5-item mFI in ventral hernia patients and determine outcomes and the relative impact of each frailty variable.
The NSQIP database was queried from 2011 to 2016 for patients undergoing VHR. Spearman's rho correlation was used to determine the degree of correlation between 11-item and 5-item mFI raw frailty scores. Chi squared testing was used to determine odds ratios (95% CI) for accumulating frailty variables in both indices with regard to complications vs a baseline of zero variables present on the 11-item scale. Complications were defined by the Clavien-Dindo (CD) classification. Univariate and multivariate analyses were performed on each frailty variable to determine their relative weighted impacts on outcomes.
97,905 patients (99.45%) had all five frailty variables recorded. Only 11,549 patients (11.73%) had all variables from the 11-item mFI. No difference existed between groups for the five mutually shared frailty variables, BMI, emergent vs non-emergent procedures, operative time, or operative approach. For accumulating variables in both indices, the 5-item mFI predicts incidence of any complications, major complications, and discharge not to home similarly to the 11-item mFI. The most significantly weighted variable for complications and discharge not to home is functional status.
A 5-item mFI accurately predicts outcomes similar to the validated 11-item mFI and captures more patients for analysis.
衰弱是一种与正常衰老过程分离的生理储备减少。先前，使用 NSQIP 变量的 11 项改良衰弱指数（mFI）预测了手术患者的结果。我们旨在验证腹疝患者的简化 5 项 mFI，并确定结果和每个衰弱变量的相对影响。
从 2011 年到 2016 年，NSQIP 数据库被查询用于接受 VHR 的患者。Spearman 的 rho 相关用于确定 11 项和 5 项 mFI 原始衰弱评分之间的相关性程度。卡方检验用于确定在两个指数中，累积虚弱变量与并发症的比值比（95%CI），与基线相比，零变量存在于 11 项量表上。并发症由 Clavien-Dindo（CD）分类定义。对每个衰弱变量进行单变量和多变量分析，以确定它们对结果的相对加权影响。
97905 名患者（99.45%）记录了所有五个衰弱变量。只有 11549 名患者（11.73%）记录了 11 项 mFI 的所有变量。两组之间在五个相互共享的衰弱变量、BMI、紧急与非紧急手术、手术时间或手术方法方面没有差异。对于两个指数中的累积变量，5 项 mFI 预测任何并发症、主要并发症和出院到非家庭的发生率与 11 项 mFI 相似。对并发症和出院到非家庭最重要的加权变量是功能状态。
5 项 mFI 准确预测结果与经过验证的 11 项 mFI 相似，并捕获更多的患者进行分析。
