患者虚弱程度作为长骨骨折手术治疗中的一种风险评估工具。

Patient frailty as a risk assessment tool in surgical management of long bone fractures.

作者信息

Amer Kamil M, Congiusta Dominick V, Suri Pooja, Merchant Aziz M, Vosbikian Michael M, Ahmed Irfan H

机构信息

Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, United States.

出版信息

J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S591-S595. doi: 10.1016/j.jcot.2020.01.007. Epub 2020 Jan 23.

DOI:10.1016/j.jcot.2020.01.007

PMID:32774034

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7394786/

Abstract

BACKGROUND

Frailty is an important predictor of surgical outcomes and has been quantified by several models. The modified frailty index (mFI) has recently been adapted from an 11-item index to a 5-item index and has promise to be a valuable risk assessment tool in orthopedic trauma patients. We perform a retrospective analysis of the 5-item mFI and evaluate its effectiveness in predicting outcomes in patients with long bone fractures.

METHODS

The National Surgery Quality Improvement Program (NSQIP) 2006-2016 database was queried for surgical procedures in the treatment of long bone fractures by current procedural terminology (CPT) codes, excluding those performed on metacarpals and metatarsals. Cases were excluded if they were missing demographic, frailty, and variable data. The 5-item frailty index was calculated based on the sum of presence of 5 conditions: COPD/pneumonia, congestive heart failure, diabetes, hypertension, and impaired functional status. Chi square was used to determine variables significantly associated with each outcome. The significant variables were included in multivariate logistic regression along with the mFI. Significance was defined as < 0.05.

RESULTS

Of the 140,249 fixation procedures performed on long bone fractures in NSQIP, 109,423 cases remained after exclusion criteria were applied. The majority of patients were between the ages of 61 and 80 (34.0%), were female (65.6%) and Caucasian (86.3%). Multivariate analysis revealed that mFI scores ≥3 were predictive of unplanned reoperation (OR = 1.57), wound disruption (OR = 2.83), unplanned readmission (OR = 2.12), surgical site infection (OR = 1.90), major complications (OR = 3.04), and discharge destination (OR = 3.06).

CONCLUSIONS

Our study analyzed the relationship of frailty and postoperative complications in patients with long bone fractures. Patients had increased likelihood of morbidity, independent of other comorbidities and demographic factors. The mFI may have a role as a simple, easy to use risk assessment tool in cases of orthopedic trauma.

摘要

背景

虚弱是手术预后的重要预测指标，已有多种模型对其进行量化。改良虚弱指数（mFI）最近已从一个11项指标改编为一个5项指标，有望成为骨科创伤患者有价值的风险评估工具。我们对5项mFI进行回顾性分析，并评估其在预测长骨骨折患者预后方面的有效性。

方法

通过当前手术操作术语（CPT）编码，在2006 - 2016年国家外科质量改进计划（NSQIP）数据库中查询长骨骨折治疗的手术程序，排除在手和足部掌骨及跖骨上进行的手术。如果病例缺少人口统计学、虚弱和变量数据，则予以排除。基于慢性阻塞性肺疾病/肺炎、充血性心力衰竭、糖尿病、高血压和功能状态受损这5种情况的存在总和计算5项虚弱指数。采用卡方检验确定与各预后显著相关的变量。将显著变量与mFI一起纳入多因素逻辑回归分析。显著性定义为P < 0.05。

结果

在NSQIP中对长骨骨折进行的140,249例固定手术中，应用排除标准后剩余109,423例病例。大多数患者年龄在61至80岁之间（34.0%），为女性（65.6%）且是白种人（86.3%）。多因素分析显示，mFI评分≥3可预测计划外再次手术（OR = 1.57）、伤口裂开（OR = 2.83）、计划外再次入院（OR = 2.12）、手术部位感染（OR = 1.90）、主要并发症（OR = 3.04）和出院去向（OR = 3.06）。