Ramanathan Rajesh, Rieser Caroline, Kurtom Saba, Rustom Salem, Subramany Revathy, Wolfe Luke G, Kaplan Brian J
Division of Surgical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona.
Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
J Surg Oncol. 2020 Feb;121(2):249-257. doi: 10.1002/jso.25767. Epub 2019 Dec 2.
Preoperatively identifying patients who will require discharge to extended care facilities (ECFs) after major cancer surgery is valuable. This study compares existing models and derives a simple, preoperative tool for predicting discharge destination after major oncologic gastrointestinal surgery.
The American College of Surgeon National Surgical Quality Improvement datasets were used to evaluate existing risk stratification and frailty assessment tools between the years 2011 and 2015. A novel tool for predicting discharge to ECF was developed in the 2011-2015 dataset and subsequently validated in the 2016 dataset.
Major resections were analyzed for 61 683 malignancies: 6.9% esophagus, 5.3% stomach, 20.0% liver, 21.0% pancreas, and 46.8% colon/rectum. The overall ECF discharge rate was 9.1%. The American Society of Anesthesiologist score, 11-point modified frailty index (mFI), and 5-point abbreviated modified frailty index (amFI) demonstrated only moderate discrimination in predicting ECF discharge (c-statistic: 0.63-0.65). In contrast, our weighted cancer cancer abbreviated modified frailty index (camFI) score demonstrated improved discrimination with c-statistic of 0.73. The camFI displayed >90% negative predictive value for ECF discharge at every operative site.
The camFI is a simple tool that can be used preoperatively to counsel patients on their risk of ECF discharge, and to identify patients with the least need for ECF discharge after major oncologic gastrointestinal surgery.
术前识别出重大癌症手术后需要转至长期护理机构（ECF）的患者很有价值。本研究比较了现有模型，并得出一种简单的术前工具，用于预测重大肿瘤性胃肠手术后的出院去向。
利用美国外科医师学会国家外科质量改进数据集评估2011年至2015年间现有的风险分层和虚弱评估工具。在2011 - 2015年的数据集中开发了一种预测转至ECF的新型工具，并随后在2016年的数据集中进行了验证。
对61683例恶性肿瘤的大手术切除病例进行了分析：食管癌6.9%，胃癌5.3%，肝癌20.0%，胰腺癌21.0%，结肠/直肠癌46.8%。总体ECF出院率为9.1%。美国麻醉医师协会评分、11分改良虚弱指数（mFI）和5分简化改良虚弱指数（amFI）在预测ECF出院方面仅表现出中等的区分度（c统计量：0.63 - 0.65）。相比之下，我们的加权癌症简化改良虚弱指数（camFI）评分的区分度有所提高，c统计量为0.73。在每个手术部位，camFI对ECF出院的阴性预测值均>90%。
camFI是一种简单的工具，可在术前用于告知患者其转至ECF出院的风险，并识别出重大肿瘤性胃肠手术后最不需要转至ECF出院的患者。
