Department of Obstetrics & Gynecology, Columbia University College of Physicians & Surgeons, New York, NY, United States of America.
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, MA, United States of America.
Gynecol Oncol. 2020 Nov;159(2):426-433. doi: 10.1016/j.ygyno.2020.08.024. Epub 2020 Aug 28.
Frailty, defined as loss of reserve and vulnerability to changes in health, affects many ovarian cancer patients who are planned to undergo surgery. The effect of frailty on postoperative readmissions in ovarian cancer patients remains poorly defined. We investigated the effect of frailty on unplanned readmission, morbidity, and mortality among patients undergoing surgery for ovarian cancer.
Patients who underwent laparotomy for ovarian cancer between 2010 and 2014 were identified using the Nationwide Readmissions Database. Frailty was classified using the Johns Hopkins Adjusted Clinical Groups Frailty Diagnoses Indicators. Primary outcomes were divided into index admission (intensive level of care, mortality, non-routine discharge,) 30-days (readmission and mortality), and 90-days (readmission and mortality). Multivariable regression models were fit, adjusting for patient, hospital, and clinical factors.
From 2010 to 2014, there were 76,441 inpatient laparotomies identified with a 6.1% frailty rate. Frailty was associated with an increased risk of intensive level of care (aRR = 1.76, 95% CI: 1.68, 1.85), non-routine discharge (aRR = 1.39, 95% CI: 1.33, 1.45), and inpatient mortality (aRR = 1.91, 95% CI: 1.63, 2.23) during the index admission. Frail patients were more likely to be readmitted within 90 days (aRR = 1.11, 95% CI: 1.04-1.18), sustain mortality during 90-day readmission (aRR = 1.31, 95% CI 1.01-1.69), and have longer and costlier index hospital stays. Hospital readmission costs did not differ significantly between frail and non-frail patients.
Frailty affects postoperative outcomes in ovarian cancer patients and is associated with an increased rate of 90-day readmission and mortality among those who are readmitted. Gynecologic oncologists should screen for frailty and consider outcomes in frail ovarian cancer patients when counseling for surgery.
虚弱，定义为储备减少和对健康变化的脆弱性，影响许多计划接受手术的卵巢癌患者。虚弱对卵巢癌患者术后再入院的影响仍未得到明确界定。我们调查了虚弱对接受卵巢癌手术患者的非计划性再入院、发病率和死亡率的影响。
使用全国再入院数据库确定了 2010 年至 2014 年间接受剖腹手术的卵巢癌患者。使用约翰霍普金斯调整临床组虚弱诊断指标对虚弱进行分类。主要结果分为入院时（强化护理水平、死亡率、非常规出院）、30 天（再入院和死亡率）和 90 天（再入院和死亡率）。调整患者、医院和临床因素后，拟合多变量回归模型。
2010 年至 2014 年，共确定了 76441 例住院剖腹术，虚弱率为 6.1%。虚弱与强化护理水平（ARR=1.76，95%CI：1.68，1.85）、非常规出院（ARR=1.39，95%CI：1.33，1.45）和住院死亡率（ARR=1.91，95%CI：1.63，2.23）的风险增加相关。虚弱患者在 90 天内再次入院的可能性更大（ARR=1.11，95%CI：1.04-1.18），在 90 天再入院期间发生死亡的可能性更高（ARR=1.31，95%CI 1.01-1.69），且住院时间更长、费用更高。虚弱和非虚弱患者的医院再入院费用无显著差异。
虚弱影响卵巢癌患者的术后结局，与再入院患者的 90 天再入院率和死亡率增加相关。妇科肿瘤医生在为手术咨询时应筛查虚弱，并考虑虚弱卵巢癌患者的结局。
