Cihoric Mirjana, Tengberg Line Toft, Foss Nicolai Bang, Gögenur Ismail, Tolstrup Mai-Britt, Bay-Nielsen Morten
1Department of Anaesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Hvidovre, Kettegaard allé 30, 2650 Hvidovre, Copenhagen, Denmark.
2Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark.
Perioper Med (Lond). 2020 May 5;9:13. doi: 10.1186/s13741-020-00143-7. eCollection 2020.
Despite the importance of predicting adverse postoperative outcomes, functional performance status as a proxy for frailty has not been systematically evaluated in emergency abdominal surgery. Our aim was to evaluate if the Eastern Cooperative Oncology Group (ECOG) performance score was independently associated with mortality following high-risk emergency abdominal surgery, in a multicentre, retrospective, observational study of a consecutive cohort.
All patients aged 18 or above undergoing high-risk emergency laparotomy or laparoscopy from four emergency surgical centres in the Capitol Region of Denmark, from January 1 to December 31, 2012, were included. Demographics, preoperative status, ECOG performance score, mortality, and surgical characteristics were registered. The association of frailty with postoperative mortality was evaluated using multiple regression models. Likelihood ratio test was applied for goodness of fit.
In total, 1084 patients were included in the cohort; unadjusted 30-day mortality was 20.2%. ECOG performance score was independently associated with 30-day mortality. Odds ratio for mortality was 1.70 (95% CI (1.0, 2.9)) in patients with ECOG performance score of 1, compared with 5.90 (95% CI (1.8, 19.0)) in patients with ECOG performance score of 4 ( < 0.01). Likelihood ratio test suggests improvement in fit of logistic regression modelling of 30-day postoperative mortality when including ECOG performance score as an explanatory variable.
This study found ECOG performance score to be independently associated with the postoperative 30-day mortality among patients undergoing high-risk emergency laparotomy. The utility of including functional performance in a preoperative risk assessment model of emergency laparotomy should be evaluated.
尽管预测术后不良结局很重要，但在急诊腹部手术中，作为虚弱替代指标的功能表现状态尚未得到系统评估。我们的目的是在一项多中心、回顾性、观察性连续队列研究中，评估东部肿瘤协作组（ECOG）体能状态评分是否与高危急诊腹部手术后的死亡率独立相关。
纳入2012年1月1日至12月31日期间在丹麦首都地区四个急诊外科中心接受高危急诊剖腹手术或腹腔镜手术的所有18岁及以上患者。记录人口统计学、术前状态、ECOG体能状态评分、死亡率和手术特征。使用多元回归模型评估虚弱与术后死亡率的关联。采用似然比检验评估拟合优度。
该队列共纳入1084例患者；未经调整的30天死亡率为20.2%。ECOG体能状态评分与30天死亡率独立相关。ECOG体能状态评分为1的患者死亡率的比值比为1.70（95%可信区间（1.0，2.9）），而ECOG体能状态评分为4的患者为5.90（95%可信区间（1.8，19.0））（P<0.01）。似然比检验表明，将ECOG体能状态评分作为解释变量纳入时，30天术后死亡率的逻辑回归模型拟合度有所改善。
本研究发现ECOG体能状态评分与接受高危急诊剖腹手术患者的术后30天死亡率独立相关。应评估在急诊剖腹手术术前风险评估模型中纳入功能表现的效用。
