Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Department of General Surgery, Khoo Teck Puat Hospital, Singapore.
J Surg Res. 2020 Dec;256:549-556. doi: 10.1016/j.jss.2020.07.012. Epub 2020 Aug 13.
Assessment of preoperative handgrip strength (HGS) is an objective and inexpensive bedside tool, which has been investigated to predict morbidity risk in elective surgery. However, its use is not validated in patients undergoing major elective hepatobiliary surgery (MEHS). The aim of this study is to investigate the use of HGS to predict morbidity in patients undergoing MEHS.
This is a single-center prospective study involving 81 patients who underwent MEHS over 21 mo from July 2014 to March 2016. MEHS was defined as any hepatobiliary surgery expected to last more than 2 h and/or with an anticipated blood loss of ≥500 mL. HGS was assessed in both dominant and nondominant hands with standardization and subsequently recorded and expressed as a percentage of a general, age- and gender-matched normative values.
The mean age was 65.2 ± 9.5 y with male predominance (n = 52, 64.2%). Approximately, half of the patients underwent liver resection (n = 43, 53.1%). There was no difference in the incidence of Clavien-Dindo ≥ grade IIIA in both dominant HGS (impaired HGS 8/33 [24.2%], normal HGS 6/48 [12.5%]; P = 0.170) and nondominant HGS (impaired HGS 8/33 [21.1%], normal HGS 6/43 [14%]; P = 0.399). Dominant and nondominant HGS showed poor discriminatory ability in the prediction of Clavien-Dindo ≥ grade IIIA complications (dominant HGS area under the curve [AUC] = 0.572; nondominant HGS AUC 0.545). However, the use of dominant HGS showed moderate discriminatory ability to predict the length of hospital stay ≥21 d (AUC = 0.759).
The use of HGS may not predict Clavien-Dindo ≥ grade IIIA complications, but predicts a prolonged length of hospital stay ≥21 d.
术前握力（HGS）评估是一种客观且廉价的床边工具，已被用于预测择期手术的发病率风险。然而，其在接受重大择期肝胆手术（MEHS）的患者中的应用尚未得到验证。本研究旨在探讨 HGS 在预测 MEHS 患者发病率方面的应用。
这是一项单中心前瞻性研究，纳入了 2014 年 7 月至 2016 年 3 月期间接受 MEHS 的 81 例患者。MEHS 定义为任何预计持续时间超过 2 小时和/或预计出血量≥500ml 的肝胆手术。使用标准化方法评估优势手和非优势手的 HGS，随后记录并表示为与一般人群、年龄和性别匹配的正常值的百分比。
平均年龄为 65.2±9.5 岁，男性居多（n=52，64.2%）。大约一半的患者接受了肝切除术（n=43，53.1%）。在优势手 HGS（受损 HGS 8/33 [24.2%]，正常 HGS 6/48 [12.5%]；P=0.170）和非优势手 HGS（受损 HGS 8/33 [21.1%]，正常 HGS 6/43 [14%]；P=0.399）中，Clavien-Dindo≥grade IIIA 的发生率无差异。优势手和非优势手 HGS 在预测 Clavien-Dindo≥grade IIIA 并发症方面的区分能力较差（优势手 HGS 曲线下面积 [AUC]为 0.572；非优势手 HGS AUC 为 0.545）。然而，使用优势手 HGS 预测住院时间≥21d 具有中等的区分能力（AUC=0.759）。
HGS 的使用可能无法预测 Clavien-Dindo≥grade IIIA 并发症，但可预测住院时间≥21d。
