Department of Surgery, Division of Vascular Surgery, University of Iowa, Iowa City, Iowa.
J Surg Res. 2021 Aug;264:179-185. doi: 10.1016/j.jss.2021.02.015. Epub 2021 Apr 6.
Frailty scores are increasingly utilized to predict postoperative complications. The purpose of this study is to determine whether the administrative risk analysis index (RAI-A) can be used to predict reintervention or mortality within 30 days in patients who undergo elective open or endovascular abdominal aortic aneurysm (AAA) repair.
The American College of Surgeons National Surgical Quality Improvement Program database was used to query data from elective open or endovascular aortic aneurysm repairs from 2011 to 2018. The administrative risk analysis index (RAI-A) score was calculated for each patient using two approaches (conservative versus liberal) due to discrepancies in NSQIP data categorization. Multivariable regression analysis was performed to determine whether there were statistical or clinical significance for incremental increases of RAI-A for both the open and endovascular repair group. Outcome measures were re-intervention or death within 30 days.
Data from 4106 and 11,733 patients who underwent open and endovascular repair, respectively, were included in the analysis. The number of reinterventions within 30 days was 9.1% (375 out of 4106 patients) in the open repair group and 4.0% (463 out of 11,685 patients) in the endovascular group. Thirty-day mortality was 4.7% (192 out of 4106 patients) in the open repair group, and 0.9% (109 out of 11,685 patients) in the endovascular group. In the conservative calculation of RAI-A scores, the open and endovascular repair groups had median RAI-A scores of 7 (mean 8.31) and 9 (mean 9.51), respectively. There was no significant association between RAI-A scores and outcome measures in either group. For predicting 30 d reintervention, the C statistic was 0.535 (OR 1.02) for the open repair group and 0.532 (OR 1.02) for endovascular repair. For predicting 30-day mortality, the C statistic was 0.626 (OR 1.07) in the open repair group and 0.701 (OR 1.09) in the endovascular repair group. In the liberal calculation of RAI-A scores, the open and endovascular repair groups had median RAI-A scores of 6 (mean 6.19) and 7 (mean 7.65), respectively. There was no significant association between RAI-A scores and outcome measures in either group. For predicting 30 d reintervention, the C statistic was 0.527 (OR 1.02) for open repair and 0.529 (OR 1.02) for endovascular repair. For predicting 30-day mortality, the C statistic was 0.625 (OR 1.07) in the open repair group and 0.695 (OR 1.08) in the endovascular repair group.
The RAI-A is not useful in predicting 30 d reintervention or mortality in patients who undergo elective open or endovascular AAA repair.
衰弱评分越来越多地被用于预测术后并发症。本研究的目的是确定行政风险分析指数（RAI-A）是否可用于预测择期开放或血管内腹主动脉瘤（AAA）修复后 30 天内的再干预或死亡率。
使用美国外科医师学会国家手术质量改进计划数据库，查询 2011 年至 2018 年择期开放或血管内主动脉瘤修复的数据。由于 NSQIP 数据分类存在差异，因此使用两种方法（保守与自由）计算每位患者的行政风险分析指数（RAI-A）评分。采用多变量回归分析，确定 RAI-A 在开放和血管内修复组中递增是否具有统计学或临床意义。主要观察指标为 30 天内的再干预或死亡。
共纳入 4106 例开放修复和 11733 例血管内修复患者的数据。开放修复组 30 天内再干预的例数为 9.1%（375 例/4106 例），血管内修复组为 4.0%（463 例/11685 例）。开放修复组 30 天死亡率为 4.7%（192 例/4106 例），血管内修复组为 0.9%（109 例/11685 例）。在 RAI-A 评分的保守计算中，开放和血管内修复组的 RAI-A 中位数分别为 7（平均 8.31）和 9（平均 9.51）。两组均未发现 RAI-A 评分与结局指标之间存在显著相关性。对于预测 30d 再干预，开放修复组的 C 统计量为 0.535（OR 1.02），血管内修复组为 0.532（OR 1.02）。对于预测 30 天死亡率，开放修复组的 C 统计量为 0.626（OR 1.07），血管内修复组为 0.701（OR 1.09）。在 RAI-A 评分的自由计算中，开放和血管内修复组的 RAI-A 中位数分别为 6（平均 6.19）和 7（平均 7.65）。两组均未发现 RAI-A 评分与结局指标之间存在显著相关性。对于预测 30d 再干预，开放修复组的 C 统计量为 0.527（OR 1.02），血管内修复组为 0.529（OR 1.02）。对于预测 30 天死亡率，开放修复组的 C 统计量为 0.625（OR 1.07），血管内修复组为 0.695（OR 1.08）。
RAI-A 不能用于预测择期开放或血管内 AAA 修复后 30 天内的再干预或死亡率。
