Arai Yasuhiro, Kimura Toru, Takahashi Yuki, Hashimoto Takashi, Arakawa Mamoru, Okamura Homare
Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2019 Nov;67(11):917-924. doi: 10.1007/s11748-019-01121-7. Epub 2019 Apr 5.
Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR.
Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100 m walking within 7 days after surgery (successful CR group) and 31 patients who achieved 100 m walking later than 8 days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale.
The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18-1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30-10.51, p = 0.014).
Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.
术前衰弱会影响心血管手术后心脏康复（CR）的进程。有多种衰弱评估方法。然而，哪种工具最有可能预测CR的进程仍不清楚。我们的目的是使用不同方法评估术前衰弱，并确定术后CR进程中的预测因素。
2016年5月至2018年4月期间，89例患者在我院接受了择期心血管手术。排除死亡病例和未评估术前衰弱的患者。本研究纳入了其余78例患者。我们将患者分为两组：47例术后7天内完成100米步行的患者（成功CR组）和31例术后8天以后完成100米步行的患者（延迟CR组）。使用居家养老检查表、心血管健康研究、简短体能测试电池和临床衰弱量表评估术前衰弱。
这四种方法定义的衰弱在延迟CR组中的患病率更高。延迟CR组的营养状况、血清血红蛋白水平、血清白蛋白水平和腰大肌指数较低。多变量分析显示，居家养老检查表评分是延迟CR的独立预测因素（比值比1.53，95%置信区间1.18-1.98，p = 0.001），临床衰弱量表是出院至医疗机构的独立预测因素（比值比3.70，95%置信区间1.30-10.51，p = 0.014）。
在评估衰弱的各种工具中，居家养老检查表最有可能预测择期心血管手术后术后CR的进程。
