Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Eur J Vasc Endovasc Surg. 2019 Nov;58(5):762-769. doi: 10.1016/j.ejvs.2019.04.031. Epub 2019 Oct 18.
Frailty is a state of increased vulnerability and is a stronger predictor for post-operative outcome than age alone. The aim of this study was to determine whether frailty is associated with adverse 30 day outcome in vascular surgery patients.
This was a prospective cohort study. All electively operated vascular surgery patients between March 2010 and October 2017 (n = 1201), aged ≥ 60 years were evaluated prospectively. Exclusion criteria were arteriovenous access surgery, percutaneous interventions and minor amputations, resulting in 825 patients for further analysis whereas 195 had incomplete data on Groningen Frailty Indicator (GFI) and were excluded. Frailty was measured using the GFI, a screening tool covering 16 items in the domains of functioning. Patients with a total score of ≥4 were classified as frail. The primary outcome parameter was 30 day morbidity (based on the Comprehensive Complication Index). Secondary outcome measures were 30 day mortality, hospital readmission, and type of care facility after discharge. Outcomes were adjusted for sex, body mass index, smoking status, hypertension, Charlson Comorbidity Index, and type of intervention.
There was an unequal sex distribution (77.6% male). The mean age was 72.1 years. One hundred and eighty-four patients (22.3%) were considered frail. The mean Comprehensive Complication Index was 8.5. Frail patients had a significantly higher Comprehensive Complication Index (3.7 point increase, p = .005). Patients with impaired cognition and reduced psychosocial condition, two domains of the GFI, had a significantly higher Comprehensive Complication Index. Also, the 30 day mortality rate was higher in frail patients (2.7 point increase; p = .05), and they were discharged to a care facility more often (7.7 point increase; p < .001). There was no significant difference in readmission rates between frail and non-frail patients.
Frailty is associated with a higher risk of post-operative complications and discharge to a nursing home after vascular surgery. Some frailty domains (mobility, nutrition, cognition and psychosocial condition) appear to have a more pronounced impact.
衰弱是一种易损状态，其对术后结果的预测作用强于年龄。本研究旨在确定衰弱是否与血管外科患者术后 30 天不良结局相关。
这是一项前瞻性队列研究。2010 年 3 月至 2017 年 10 月期间，所有择期接受血管外科手术的年龄≥60 岁患者（n=1201）均前瞻性评估。排除动静脉通路手术、经皮介入和小截肢患者，最终纳入 825 例患者进行进一步分析，其中 195 例患者的 Groningen 衰弱指数（GFI）数据不完整，予以排除。使用 GFI 测量衰弱情况，该筛查工具涵盖了功能领域的 16 项内容。总分≥4 分的患者被归类为衰弱。主要结局参数为 30 天发病率（基于综合并发症指数）。次要结局参数为 30 天死亡率、住院再入院和出院后的护理机构类型。结果调整了性别、体重指数、吸烟状况、高血压、Charlson 合并症指数和干预类型。
存在性别分布不均（77.6%为男性）。平均年龄为 72.1 岁。184 例（22.3%）患者被认为衰弱。平均综合并发症指数为 8.5。衰弱患者的综合并发症指数显著更高（增加 3.7 分，p=0.005）。认知功能受损和社会心理状况较差的患者（GFI 的两个领域）的综合并发症指数显著更高。此外，衰弱患者的 30 天死亡率更高（增加 2.7 分；p=0.05），更常被送往护理机构（增加 7.7 分；p<0.001）。衰弱患者与非衰弱患者的再入院率无显著差异。
衰弱与血管外科术后并发症风险增加和术后入住疗养院相关。一些衰弱领域（移动能力、营养、认知和社会心理状况）的影响更为明显。
