简单的虚弱筛查工具可预测急诊手术中的功能丧失。
Prediction of functional loss in emergency surgery is possible with a simple frailty screening tool.
机构信息
Department of General Surgery, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy.
Department of General Surgery, Ospedale per gli Infermi, Viale Stadone, 9, -48018, Faenza, Italy.
出版信息
World J Emerg Surg. 2021 Mar 18;16(1):12. doi: 10.1186/s13017-021-00356-1.
BACKGROUND
Senior adults fear postoperative loss of independence the most, and this might represent an additional burden for families and society. The number of geriatric patients admitted to the emergency room requiring an urgent surgical treatment is rising, and the presence of frailty is the main risk factor for postoperative morbidity and functional decline. Frailty assessment in the busy emergency setting is challenging. The aim of this study is to verify the effectiveness of a very simple five-item frailty screening tool, the Flemish version of the Triage Risk Screening Tool (fTRST), in predicting functional loss after emergency surgery among senior adults who were found to be independent before surgery.
METHODS
All consecutive individuals aged 70 years and older who were independent (activity of daily living (ADL) score ≥5) and were admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 were prospectively included in the study. On admission, individuals were screened using the fTRST and additional metrics such as the age-adjusted Charlson Comorbidity Index (CACI) and the ASA score. Thirty- and 90-day complications and postoperative decline in the ADL score where recorded. Regression analysis was performed to identify preoperative predictors of functional loss.
RESULTS
Seventy-eight patients entered the study. Thirty-day mortality rate was 12.8% (10/78), and the 90-day overall mortality was 15.4% (12/78). One in every four patients (17/68) experienced a significant functional loss at 30-day follow-up. At 90-day follow-up, only 3/17 patients recovered, 2 patients died, and 12 remained permanently dependent. On the regression analysis, a statistically significant correlation with functional loss was found for fTRST, CACI, and age≥85 years old both at 30 and 90 days after surgery. fTRST≥2 showed the highest effectiveness in predicting functional loss at 90 days with AUC 72 and OR 6.93 (95% CI 1.71-28.05). The institutionalization rate with the need to discharge patients to a healthcare facility was 7.6% (5/66); all of them had a fTRST≥2.
CONCLUSION
fTRST is an easy and effective tool to predict the risk of a postoperative functional decline and nursing home admission in the emergency setting.
背景
老年人最担心术后丧失独立性，这可能给家庭和社会带来额外的负担。需要紧急手术治疗而被收入急诊室的老年患者数量正在增加，衰弱是术后发病率和功能下降的主要危险因素。在繁忙的急诊环境中评估衰弱是具有挑战性的。本研究的目的是验证一种非常简单的五项衰弱筛查工具——弗拉芒版分诊风险筛查工具（fTRST）的有效性，该工具可预测术前独立的老年患者接受急诊手术后的功能丧失。
方法
2015 年 12 月至 2016 年 5 月期间，所有连续 70 岁及以上、术前独立（日常生活活动（ADL）评分≥5）且因腹部急症需要紧急手术而被收入急诊外科的患者均前瞻性纳入研究。入院时，使用 fTRST 以及年龄调整后的 Charlson 合并症指数（CACI）和 ASA 评分等其他指标对患者进行筛查。记录术后 30 天和 90 天的并发症和 ADL 评分下降情况。回归分析用于确定术后功能丧失的术前预测因子。
结果
78 例患者入组。30 天死亡率为 12.8%（10/78），90 天总死亡率为 15.4%（12/78）。四分之一的患者（17/68）在 30 天随访时出现明显的功能丧失。90 天随访时，仅 17 例患者中的 3 例恢复，2 例死亡，12 例患者仍永久性依赖。回归分析显示，fTRST、CACI 和年龄≥85 岁与术后 30 天和 90 天的功能丧失均有统计学显著相关性。fTRST≥2 在预测 90 天的功能丧失方面最有效，AUC 为 72，OR 为 6.93（95%CI 1.71-28.05）。需要将患者送往医疗机构的机构化率为 7.6%（5/66）；他们都有 fTRST≥2。
结论
fTRST 是一种在急诊环境中预测术后功能下降和疗养院入院风险的简单而有效的工具。
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