Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
Aging Clin Exp Res. 2021 Aug;33(8):2191-2201. doi: 10.1007/s40520-020-01735-5. Epub 2020 Nov 18.
Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery.
1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called "EmSFI". Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score.
784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654-0.772]; HL test χ = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682-0.842]; HL test χ = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort.
The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.
虚弱评估近年来变得越来越重要，已经证明这种脆弱的状态使老年患者在手术后的预后更差。因此，在进行紧急手术的老年患者中进行准确的手术风险分层变得至关重要。
2016 年 12 月至 2017 年 5 月，来自参与多中心 FRAILESEL（老年人脆弱性和急诊手术）研究的 38 个意大利中心的 1024 名 65 岁以上需要紧急手术的患者前瞻性地被招募。进行了单变量分析，目的是开发一种称为“EmSFI”的急诊手术虚弱指数。然后进行接受者操作特征曲线分析来测试我们的预测评分的准确性。
连续纳入 784 名老年患者，构成开发组，并考虑进一步纳入 240 名接受结直肠手术的连续患者来验证结果。进行了逻辑回归分析，确定了不同的 EmSFI 风险等级。该模型在开发组（AUC=0.731 [95%CI 0.654-0.772]；HL 检验 χ=6.780；p=0.238）和验证组（AUC=0.762 [95%CI 0.682-0.842]；HL 检验 χ=7.238；p=0.299）的死亡率方面表现出良好的准确性。关于发病率，我们的模型在开发组中显示出中度准确性，而在验证队列中观察到较差的鉴别能力。
验证后的 EmSFI 是一种可靠且省时的工具，尽管其在并发症方面的鉴别能力有所下降。因此，需要进一步研究专门的手术环境，验证 EmSFI 在评估与手术相关的发病率风险方面的预后作用。
