虚弱对人工尿道括约肌置入和移除程序的影响。
The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures.
机构信息
Department of Urology, University of California, Los Angeles (UCLA), Los Angeles, CA.
Department of Urology, University of California, Los Angeles (UCLA), Los Angeles, CA; Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
出版信息
Urology. 2019 Jul;129:210-216. doi: 10.1016/j.urology.2019.04.015. Epub 2019 Apr 19.
OBJECTIVE
To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure.
METHODS
This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2013. Frailty was quantified using the NSQIP-FI (frailty index) and was applied to logistic regression models predicting 30-day complications (overall, major, and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure).
RESULTS
We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% confidence interval 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% confidence interval 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, P<.01).
CONCLUSION
Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.
目的
确定虚弱是否与接受人工尿道括约肌（AUS）植入和取出手术的男性患者 30 天内发生手术并发症的风险增加相关，以及虚弱是否与 AUS 取出手术的风险增加相关。
方法
这是一项回顾性队列研究，使用了美国外科医师学会国家手术质量改进计划（ACS-NSQIP）2006 年至 2013 年的数据，对接受 AUS 植入和取出手术的男性患者进行研究。使用 NSQIP-FI（虚弱指数）来量化虚弱，并将其应用于预测 30 天内并发症（总体、主要和次要）和 AUS 取出手术（与 AUS 植入手术相比）的可能性的逻辑回归模型中。
结果
我们共确定了 624 名和 147 名分别接受 AUS 植入和取出手术的男性患者。NSQIP-FI≥0.27，但不是年龄，与主要并发症相关（aOR 3.5，95%置信区间 1.2-9.9），而年龄≥85 岁，但不是 NSQIP-FI，与次要并发症相关（aOR 7.9，95%置信区间 1.4-45.6）。与接受 AUS 植入手术的男性相比，接受 AUS 取出手术的男性往往更虚弱（12.9% vs 6.1%的患者 NSQIP-FI≥0.27，P<.01）。
结论
与接受 AUS 植入手术的男性相比，接受 AUS 取出手术的男性平均更虚弱。虚弱与主要并发症的风险增加以及 AUS 取出手术的风险增加相关。这些发现强调了在考虑这些类型手术的成年人的围手术期决策过程中，除了年龄外，还应纳入虚弱程度的措施的重要性。
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