Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
Eur J Surg Oncol. 2021 Apr;47(4):888-895. doi: 10.1016/j.ejso.2020.09.009. Epub 2020 Sep 16.
Frailty is an important prognostic factor, and the association with postoperative dependence is important outcome to older adults. We examined the association of frailty with long-term homecare utilization for older adults following cancer surgery.
In this population-based cohort study, we determined frailty status in all older adults (≥70 years old) undergoing cancer resection (2007-2017). Outcomes were receipt of homecare and intensity of homecare (days per month) over 5 years. We estimated the adjusted association of frailty with outcomes, and assessed interaction with age.
Of 82,037 patients, 6443 (7.8%) had frailty. Receipt and intensity of homecare was greater with frailty, but followed similar trajectories over 5 years between groups. Homecare receipt peaked in the first postoperative month (51.4% frailty, 43.1% no frailty), and plateaued by 1 year until 5 years (28.5% frailty, 12.8% no frailty). After 1 year, those with frailty required 4 more homecare days per month than without frailty (14 vs 10 days/month). After adjustment, frailty was associated with increased homecare receipt (hazard ratio 1.40; 95%CI 1.35-1.45), and increasing intensity each year (year 1 incidence rate ratio [IRR] 1.22, 95%CI 1.18-1.27 to year 5 IRR 1.47, 95%CI 1.35-1.59). The magnitude of the association of frailty with homecare receipt decreased with age (p <0.001).
While the trajectory of homecare receipt and intensity is similar between those with and without frailty, frailty is associated with increased receipt of homecare and increased intensity of homecare after cancer surgery across all age groups.
衰弱是一个重要的预后因素，与术后依赖的关系是老年人的重要结局。我们研究了衰弱与癌症手术后老年人长期家庭护理利用的关系。
在这项基于人群的队列研究中，我们确定了所有（≥70 岁）接受癌症切除术的老年人的衰弱状况（2007-2017 年）。结果是在 5 年内接受家庭护理的情况和家庭护理的强度（每月天数）。我们估计了衰弱与结局的调整关联，并评估了与年龄的相互作用。
在 82037 名患者中，有 6443 名（7.8%）患有衰弱。衰弱患者的家庭护理接受程度和强度更高，但两组在 5 年内的轨迹相似。家庭护理的接受程度在术后第一个月达到高峰（衰弱者为 51.4%，无衰弱者为 43.1%），并在 1 年内稳定到 5 年（衰弱者为 28.5%，无衰弱者为 12.8%）。1 年后，衰弱患者每月需要的家庭护理天数比不衰弱患者多 4 天（14 天/月比 10 天/月）。调整后，衰弱与家庭护理的增加接受有关（风险比 1.40；95%CI 1.35-1.45），并且每年的强度都在增加（第 1 年的发生率比 [IRR] 为 1.22，95%CI 为 1.18-1.27，到第 5 年的 IRR 为 1.47，95%CI 为 1.35-1.59）。衰弱与家庭护理接受的关联程度随年龄的增加而降低（<0.001）。
尽管衰弱患者和非衰弱患者的家庭护理接受程度和强度轨迹相似，但衰弱与癌症手术后所有年龄组的家庭护理接受程度增加和家庭护理强度增加有关。
