Tse Wayne, Newton Daniel, Amendola Michael, George Matthew, Pfeifer John
Virginia Commonwealth University Health System, Richmond, Va; Department of Surgery, McGuire Veterans Affairs Medical Center, Richmond, Va.
Virginia Commonwealth University Health System, Richmond, Va.
J Vasc Surg. 2020 Nov;72(5):1674-1680. doi: 10.1016/j.jvs.2020.01.045. Epub 2020 Mar 10.
The Risk Analysis Index (RAI) has been used to evaluate preoperative frailty, which is associated with poor short- and long-term outcomes. We assessed this tool's ability to predict postoperative outcomes after endovascular aortic aneurysm repair.
Institutional Review Board approval was obtained for this retrospective study. All patients who underwent elective endovascular aneurysm repair at a single Veterans Affairs Medical Center from December 2010 to March 2016 were included. Patients' characteristics and clinical data were retrospectively collected and analyzed. The RAI score was calculated from preoperative data, and a standard cutoff value (RAI ≥30) was used to determine frailty. Outcomes including postoperative complications, delayed discharge, and survival were compared between frail and nonfrail groups. Multivariate analysis was performed to evaluate preoperative factors associated with these outcomes.
There were 134 patients who met inclusion criteria. There were 44 frail patients (RAI ≥30) and 90 nonfrail patients (RAI <30). Frail patients had a longer hospital stay (3.9 ± 4.0 days vs 2.3 ± 1.6 days; P = .02), increased operative time (155 ± 30 minutes vs 138 ± 30 minutes; P = .002), and increased postoperative complications (43% vs 21%; P = .02) compared with nonfrail patients. Kaplan-Meier average survival for frail patients and nonfrail patients was 60 ± 4 months and 84 ± 3 months (P < .001), respectively. In multivariate analyses, frailty was associated with worse overall survival (hazard ratio, 3.7; 95% confidence interval [CI], 1.8-7.3) and higher odds of complications (odds ratio, 1.1; 95% CI, 1.0-1.14) and delayed discharge (odds ratio, 1.1; 95% CI, 1.05-1.2).
Preoperative frailty as evaluated by the RAI is associated with worse short-term postoperative outcomes and long-term mortality. The RAI can be used to inform risk-benefit discussions with patients and their families.
风险分析指数（RAI）已被用于评估术前虚弱程度，这与短期和长期不良预后相关。我们评估了该工具预测血管内主动脉瘤修复术后预后的能力。
本回顾性研究获得了机构审查委员会的批准。纳入了2010年12月至2016年3月期间在单一退伍军人事务医疗中心接受择期血管内动脉瘤修复的所有患者。回顾性收集并分析患者的特征和临床数据。根据术前数据计算RAI评分，并使用标准临界值（RAI≥30）来确定虚弱程度。比较虚弱组和非虚弱组之间包括术后并发症、延迟出院和生存率在内的预后情况。进行多变量分析以评估与这些预后相关的术前因素。
有134例患者符合纳入标准。其中44例为虚弱患者（RAI≥30），90例为非虚弱患者（RAI<30）。与非虚弱患者相比，虚弱患者的住院时间更长（3.9±4.0天对2.3±1.6天；P=0.02），手术时间增加（155±30分钟对138±30分钟；P=0.002），术后并发症增加（43%对21%；P=0.02）。虚弱患者和非虚弱患者的Kaplan-Meier平均生存期分别为60±4个月和84±3个月（P<0.001）。在多变量分析中，虚弱与较差的总生存期（风险比，3.7；95%置信区间[CI]，1.8 - 7.3）、更高的并发症发生率（比值比，1.1；95%CI，1.0 - 1.14）和延迟出院几率（比值比，1.1；95%CI，1.05 - 1.2）相关。
通过RAI评估的术前虚弱与术后短期不良预后和长期死亡率相关。RAI可用于与患者及其家属进行风险效益讨论。
