The Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 450 Lakeville Rd, New Hyde Park, NY, 11042, USA.
World J Urol. 2021 Oct;39(10):3971-3977. doi: 10.1007/s00345-021-03681-x. Epub 2021 Apr 2.
INTRODUCTION & OBJECTIVE: Surgical complications are difficult to predict, despite existing tools. Frailty phenotype has shown promise estimating postoperative risk among the elderly. We evaluate the use of frailty as a predictive tool on patients undergoing percutaneous renal surgery.
Frailty was prospectively analyzed using the Hopkins Frailty Index, consisting of 5 components yielding an additive score: patients categorized not frail, intermediate, or severely frail. Primary outcomes were complications during admission and 30-day complication rate. Secondary outcomes included overall hospital length of stay (LOS) and discharge location.
A total of 100 patients recruited, of whom five excluded as they did not need the procedure. A total of 95 patients analyzed; 69, 10, and 16 patients were not frail, intermediate, and severely frail, respectively. There were no differences in blood loss, number of dilations, presence of a staghorn calculus, laterality, or location of dilation. Severely frail patients were likely to be older and have a higher American Society of Anesthesiologists score and Charlson comorbidity index. Patients of intermediate or severe frailty were more likely to exhibit postoperative fevers, bacteremia, sepsis, and require ICU admissions (P < 0.05). Frail patients had a longer LOS (P < 0.001) and tended to require skilled assistance when discharge (p < 0.0001).
Frailty assessment appears useful stratifying those at risk of extended hospitalization, septic complications, and need for assistance following percutaneous renal surgery. Risks of sepsis, bacteremia, and post-operative hemorrhage may be higher in frail individuals. Preoperative assessment of frailty phenotype may give insight into treatment decisions and represent a modifiable marker allowing future trials exploring the concept of "prehabilitation".
尽管现有工具存在，但手术并发症仍难以预测。虚弱表型在评估老年人术后风险方面显示出了一定的潜力。我们评估了将虚弱作为预测工具用于行经皮肾手术患者的效果。
使用包含 5 个组成部分的霍普金斯虚弱指数对虚弱进行前瞻性分析，每个组成部分都有一个加和分数：将患者分为不虚弱、中度虚弱和严重虚弱。主要结局是住院期间的并发症和 30 天并发症发生率。次要结局包括总住院时间（LOS）和出院地点。
共招募了 100 名患者，其中 5 名因不需要手术而被排除。共分析了 95 名患者；69 名、10 名和 16 名患者分别为不虚弱、中度虚弱和严重虚弱。术中出血量、扩张次数、鹿角结石的存在、侧别和扩张部位无差异。严重虚弱患者更可能年龄较大，美国麻醉医师协会评分和 Charlson 合并症指数更高。中度或严重虚弱的患者更有可能出现术后发热、菌血症、败血症，需要入住重症监护病房（P < 0.05）。虚弱患者的 LOS 更长（P < 0.001），出院时更倾向于需要熟练的护理（p < 0.0001）。
虚弱评估似乎有助于对需要延长住院时间、脓毒症并发症和经皮肾手术后需要协助的患者进行风险分层。虚弱个体发生脓毒症、菌血症和术后出血的风险可能更高。术前评估虚弱表型可以深入了解治疗决策，并代表一个可改变的标志物，允许未来探索“预康复”概念的试验。
