全面老年评估对腰椎狭窄症手术后早期术后并发症的预测价值：一项前瞻性队列研究。

Predictive Value of Comprehensive Geriatric Assessment on Early Postoperative Complications Following Lumbar Spinal Stenosis Surgery: A Prospective Cohort Study.

机构信息

Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.

Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea.

出版信息

Spine (Phila Pa 1976). 2020 Nov 1;45(21):1498-1505. doi: 10.1097/BRS.0000000000003597.

DOI:10.1097/BRS.0000000000003597

PMID:32694487

Abstract

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

The aim of this study was to evaluate the predictive value of comprehensive geriatric assessment (CGA) for early postoperative complications in elderly patients (aged 65 years or older) following lumbar spinal stenosis surgery.

SUMMARY OF BACKGROUND DATA

CGA is a multidisciplinary evaluation modality proven to be effective in various fields of geriatrics. However, limited evidence exists on the effectiveness of CGA in lumbar spinal stenosis patients in the literature.

METHODS

We prospectively enrolled consecutive patients who were at least 65 years' old and were scheduled to undergo elective surgery for lumbar spinal stenosis. One day before the operation, multidomain CGA was performed on the patient's functional status, comorbidities, nutrition, cognition, and psychological status. Patients with deficits in three or more CGA domains were defined as frail. The occurrence of postoperative complications (Clavien and Dindo grade 2 or higher) within 30 days after the surgery was assessed as the outcome. The predictive value of CGA was evaluated using crosstab and logistic regression analysis and compared to that of other risk stratification systems, including modified Frailty Index-5, -11, and American Society of Anesthesiologists Physical Classification System.

RESULTS

A total of 261 patients were included in the study, and 25 (9.6%) patients were assigned to the "frail" group. There were 27 (10.3%) patients with a postoperative complication (general: n = 20, 7.7%, surgical: n = 7, 2.7%) within postoperative 30 days. Patients with a complication showed significantly more deficits on preoperative CGA than those without complications (P = 0.004). On multivariate logistic regression analysis, frailty based on CGA (odds ratio = 3.51, P = 0.031) and the modified Frailty Index-11 (odds ratio = 3.13, P = 0.038) were associated with the occurrence of general complications.

CONCLUSION

Frailty based on CGA was significantly associated with early general complications following surgery for lumbar spinal stenosis in patients older than 65 years.

LEVEL OF EVIDENCE

摘要

研究设计

前瞻性队列研究。

目的

本研究旨在评估综合老年评估（CGA）对老年（65 岁及以上）腰椎椎管狭窄症手术后早期术后并发症的预测价值。

背景资料概要

CGA 是一种多学科评估方式，已被证明在老年医学的各个领域都具有有效性。然而，文献中关于 CGA 在腰椎椎管狭窄症患者中的有效性的证据有限。

方法

我们前瞻性地招募了至少 65 岁且计划接受腰椎椎管狭窄症择期手术的连续患者。手术前一天，对患者的功能状态、合并症、营养、认知和心理状况进行多领域 CGA。在 CGA 中存在三个或更多领域缺陷的患者被定义为虚弱。评估术后 30 天内发生的术后并发症（Clavien 和 Dindo 分级 2 或更高）作为结局。使用交叉表和逻辑回归分析评估 CGA 的预测价值，并与其他风险分层系统（包括改良衰弱指数-5、-11 和美国麻醉医师协会身体状况分类系统）进行比较。

结果

共有 261 名患者纳入研究，25 名（9.6%）患者被分到“虚弱”组。术后 30 天内有 27 名（10.3%）患者发生术后并发症（一般：n=20，7.7%，手术：n=7，2.7%）。有并发症的患者在术前 CGA 上表现出明显更多的缺陷，与无并发症的患者相比，差异有统计学意义（P=0.004）。在多变量逻辑回归分析中，基于 CGA 的衰弱（比值比=3.51，P=0.031）和改良衰弱指数-11（比值比=3.13，P=0.038）与一般并发症的发生相关。