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接受心脏手术的体弱患者的30天死亡率:……的结果

30-day mortality in frail patients undergoing cardiac surgery: the results of the .

作者信息

Bäck Caroline, Hornum Mads, Olsen Peter Skov, Møller Christian H

机构信息

Department of Cardiothoracic Surgery RT, Rigshospitalet, Copenhagen University Hospital, København, Denmark.

Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, København, Denmark.

出版信息

Scand Cardiovasc J. 2019 Dec;53(6):348-354. doi: 10.1080/14017431.2019.1644366. Epub 2019 Jul 23.

Abstract

Typically, patients referred to cardiac surgery are aged. Because EuroSCORE tend to overestimate and STS tend to underestimate the risk of mortality after cardiac surgery, frailty has become interesting as a potential predictor for mortality after cardiac surgery. Therefore, we conducted a study to identify the number of frail patients undergoing cardiac surgery and describe the risk of short-term complications and mortality. . In a prospective observational study, we have compared the surgical outcome in frail versus non-frail patients. Patients aged > 65 years and undergoing non-acute cardiac surgery were included. Frailty was assessed using the comprehensive assessment of frailty (CAF) score. The CAF evaluates the patient's physical condition through performing physical tests. . 604 patients included, 477 were men and the median age was 73 years (range, 65-90). Twenty-five percent were deemed frail. Frail patients had a four times higher 30-day mortality. Furthermore, frail patients had higher postoperative complication rates of atrial fibrillation, prolonged ventilation, re-operations, renal failure, transfusion requirements, and increased length of stay. Patients who died within 30 days had a significantly higher CAF score than those who survived ( = .039). Based on ROC curves, the area under the curve (AUC) for CAF score was 0.700, EuroSCORE 0.664 and STS score 0.748. . Frailty is common in patients undergoing cardiac surgery and carries increased risk of 30-day mortality and postoperative complications. The AUC indicates similar prediction of mortality for CAF score compared to the existing risk scores. NCT02992587.

摘要

通常,被转诊至心脏外科的患者年龄较大。由于欧洲心脏手术风险评估系统(EuroSCORE)往往会高估、而胸外科医师协会(STS)风险评估系统往往会低估心脏手术后的死亡风险,衰弱作为心脏手术后死亡的潜在预测因素已引起关注。因此,我们开展了一项研究,以确定接受心脏手术的衰弱患者数量,并描述短期并发症和死亡风险。在一项前瞻性观察性研究中,我们比较了衰弱患者与非衰弱患者的手术结局。纳入年龄>65岁且接受非急性心脏手术的患者。使用衰弱综合评估(CAF)评分评估衰弱情况。CAF通过进行体格检查来评估患者的身体状况。纳入604例患者,其中477例为男性,中位年龄为73岁(范围65 - 90岁)。25%的患者被认为衰弱。衰弱患者的30天死亡率高出四倍。此外,衰弱患者术后房颤、通气时间延长、再次手术、肾衰竭、输血需求及住院时间延长等并发症发生率更高。30天内死亡的患者CAF评分显著高于存活患者(P = 0.039)。根据ROC曲线,CAF评分的曲线下面积(AUC)为0.700,EuroSCORE为0.664,STS评分为0.748。衰弱在接受心脏手术的患者中很常见,且30天死亡率和术后并发症风险增加。AUC表明,与现有风险评分相比,CAF评分对死亡率的预测效果相似。NCT02992587。

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