Chen Fan-Feng, Ye Xiao-Ning, Jiang Hao-Te, Zhu Guan-Xia, Miao Shou-Liang, Yu Guan-Feng, Qiu Yi-Hui, Huang Jing-Yong
Department of Vascular Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
Ann Vasc Surg. 2020 Aug;67:105-114. doi: 10.1016/j.avsg.2020.03.037. Epub 2020 Mar 30.
This study was performed to determine the association of frailty and comorbidity status with postoperative morbidity and mortality in patients with acute mesenteric ischemia (AMI).
Patients diagnosed with AMI between April 2006 and September 2019 were enrolled in this study. Frailty was evaluated by sarcopenia which was diagnosed by third lumbar vertebra psoas muscle area (PMA). Comorbidity status was evaluated by the Charlson Comorbidity Index (CCI) score. Univariate and multivariate analyses evaluating the risk factors for postoperative morbidity and mortality were performed.
Of the 174 patients, 86 were managed conservatively and 88 underwent surgery. In surgically managed patients, 39.8% developed complications within 30 days of surgery. Ten patients died within 30 days of the operation. In the univariate analyses, white blood cell >10 g/L, low PMA, CCI score ≥2, and bowel resection were associated with postoperative complications. Multivariate analysis revealed that low PMA, CCI score ≥2, and bowel resection were independent predictors of postoperative complications.
This study demonstrated that low PMA, CCI score ≥2, and bowel resection were independent risk factors for postoperative complications in patients with AMI. Preoperative assessment of frailty using PMA and the evaluation of comorbidity status using CCI may serve as helpful tools in preoperative risk assessment and should be integrated into scoring systems for surgically treated AMI.
本研究旨在确定急性肠系膜缺血（AMI）患者的虚弱和共病状态与术后发病率和死亡率之间的关联。
纳入2006年4月至2019年9月期间诊断为AMI的患者。通过第三腰椎腰大肌面积（PMA）诊断的肌肉减少症评估虚弱程度。通过Charlson共病指数（CCI）评分评估共病状态。进行单因素和多因素分析以评估术后发病率和死亡率的危险因素。
174例患者中，86例接受保守治疗，88例接受手术治疗。在接受手术治疗的患者中，39.8%在术后30天内出现并发症。10例患者在术后30天内死亡。在单因素分析中，白细胞>10g/L、低PMA、CCI评分≥2和肠切除术与术后并发症相关。多因素分析显示，低PMA、CCI评分≥2和肠切除术是术后并发症的独立预测因素。
本研究表明，低PMA、CCI评分≥2和肠切除术是AMI患者术后并发症的独立危险因素。使用PMA进行术前虚弱评估和使用CCI评估共病状态可能有助于术前风险评估，并应纳入手术治疗AMI的评分系统。
