多中心分析 80 岁以上患者根治性膀胱切除加输尿管皮肤造口术后的术后并发症：衰弱指数的作用。

Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy: The Role of the Frailty Index.

机构信息

Department of Urology, Ospedale Sant'Andrea-Università di Roma "Sapienza", Rome, Italy.

出版信息

Clin Genitourin Cancer. 2019 Oct;17(5):402-407. doi: 10.1016/j.clgc.2019.07.002. Epub 2019 Jul 19.

DOI:10.1016/j.clgc.2019.07.002

PMID:31402279

Abstract

BACKGROUND

The purpose of this study was to assess patient frailty as a risk factor for radical cystectomy (RC) complications.

MATERIALS AND METHODS

We performed an analysis of prospectively collected data of consecutive patients 80 years of age or older who underwent RC and ureterocutaneostomy in 6 primary care European urology centers. Frailty was measured using a simplified frailty index (sFI) with a 5-item score including: (1) diabetes mellitus; (2) functional status; (3) chronic obstructive pulmonary disease; (4) congestive cardiac failure; and (5) hypertension, with a maximum 5-item score meaning high level of frailty. Within 90 days surgical complications were scored according to the Clavien Classification System (CCS). sFI ≥3 was considered as poor frailty status. Clinical and pathological variables were analyzed as predictors of severe complications (CCS ≥3).

RESULTS

One hundred seventeen patients were enrolled. Most patients reported an sFI score of 2 and 3, respectively, 31/117 (26.5%) and 45/117 patients (38.5%). CCS ≥3 occurred in 17/117 patients (14.5%). Patients with sFI ≥3 were significantly older than patients with sFI <3 (median age, 85 years [interquartile range (IQR), 82-86] versus 82 years [IQR, 80-84]; P = .001). Most CCS ≥3 scores occurred in patients with sFI ≥3: 13 (11.1%) versus 4 (3.4%; P = .02). No significative differences were detected in terms of length of hospital stay, pathological stage, and postoperative bowel canalization when related to sFI. sFI ≥3 was an independent risk factor of CCS ≥3 in univariate and multivariate analysis (respectively, odds ratio [OR], 3.81 [95% confidence interval (CI), 1.16-12.5; P = .02] and OR, 3.1 [95% CI, 0.7-13.7; P = .01]). Body mass index, age, American Society of Anesthesiologists score ≥3, and pathological stage were not related to CCS ≥3.

CONCLUSION

RC appears feasible in elderly patients with an sFI <3. In cases of sFI ≥3, this choice should be carefully valued, discussed, and possibly avoided because of a higher risk of complications.

摘要

背景

本研究旨在评估患者虚弱程度作为根治性膀胱切除术（RC）并发症的风险因素。

材料和方法

我们对 6 个初级保健欧洲泌尿科中心连续接受 RC 和输尿管皮造口术的 80 岁或以上患者的前瞻性收集数据进行了分析。使用简化的虚弱指数（sFI）测量虚弱程度，该指数包含 5 个项目：（1）糖尿病；（2）功能状态；（3）慢性阻塞性肺疾病；（4）充血性心力衰竭；和（5）高血压，最高得分为 5 分，表示虚弱程度高。90 天内，根据 Clavien 分类系统（CCS）对手术并发症进行评分。sFI≥3 被认为是虚弱状态不佳。分析临床和病理变量作为严重并发症（CCS≥3）的预测因素。

结果

共纳入 117 例患者。大多数患者的 sFI 评分分别为 2 和 3，分别为 31/117（26.5%）和 45/117 例（38.5%）。17/117 例（14.5%）患者发生 CCS≥3。sFI≥3 的患者明显比 sFI<3 的患者年龄大（中位数年龄为 85 岁[四分位距（IQR），82-86]比 82 岁[IQR，80-84]；P=.001）。大多数 CCS≥3 评分发生在 sFI≥3 的患者中：13 例（11.1%）比 4 例（3.4%）；P=.02）。sFI 与住院时间、病理分期和术后肠道通畅情况无关。在单变量和多变量分析中，sFI≥3 是 CCS≥3 的独立危险因素（分别为优势比[OR]，3.81[95%置信区间（CI），1.16-12.5；P=.02]和 OR，3.1[95% CI，0.7-13.7；P=.01]）。体重指数、年龄、美国麻醉医师协会评分≥3 和病理分期与 CCS≥3 无关。