改良的 5 项衰弱指数是头颈部微血管重建围手术期风险的预测指标：3795 例分析。
The modified 5-item frailty index is a predictor of perioperative risk in head and neck microvascular reconstruction: An analysis of 3795 cases.
机构信息
Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA.
Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA; Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
出版信息
Am J Otolaryngol. 2021 Nov-Dec;42(6):103121. doi: 10.1016/j.amjoto.2021.103121. Epub 2021 Jun 18.
BACKGROUND
The modified frailty index 5 (mFI-5)-a scale based on the five variables diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and functional dependency-has been shown to be a valid predictor of surgical outcomes. In this study we sought to evaluate the ability of the mFI-5 to predict the postoperative outcomes of head and neck microvascular reconstruction.
METHODS
Review of the 2015-2019 American College of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) database identified 5323 cases of microvascular reconstruction, of which 3795 were head and neck cases that provided parameters necessary to calculate the mFI-5. The groups were compared in terms of demographics and comorbidities. Post-operative outcomes assessed included mortality, average operative time and length of hospital stay, surgical and medical complications, and non-home discharge.
RESULTS
Increases in the mFI were associated with longer hospitalization periods (10.5 ± 7.5 days in mFI 0 vs 14.9 ± 15.4 in mFI ≥ 3; p < 0.0001) higher rates of mortality (1% in mFI 0 vs 3.1% in mFI ≥ 3; p = 0.02), reoperation (15.4% in mFI 0 vs 17.2% in mFI ≥ 3; p = 0.002) and unplanned readmission (7.6% in mFI 0 vs 18.8% in mFI ≥ 3; p = 0.001). Rates of any complications (p < 0.0001), as well as surgical (p < 0.002) and medical (p < 0.0001) complications specifically were higher with greater mFI scores. Higher mFI scores also predicted decreased home discharge (p < 0.0001). Differences remained significant on multivariate analysis and subgroup analysis by age.
CONCLUSION
The mFI-5 is a significant predictor of risk in microvascular head and neck reconstruction. Subgroup analysis by age highlights that the tool can help identify younger patients who are frail and hence at risk. Through appropriate pre-operative identification of frail patients surgeons can prospectively modify their operative and discharge planning as well as post-operative support.
背景
基于五个变量（糖尿病、高血压、慢性阻塞性肺疾病、充血性心力衰竭和功能依赖）的改良虚弱指数 5（mFI-5）已被证明是手术结果的有效预测指标。在这项研究中，我们旨在评估 mFI-5 预测头颈部微血管重建术后结果的能力。
方法
回顾 2015-2019 年美国外科医师学会、国家外科质量改进计划（ACS NSQIP）数据库，确定了 5323 例微血管重建病例，其中 3795 例为头颈部病例，提供了计算 mFI-5 所需的参数。比较了两组的人口统计学和合并症。评估的术后结果包括死亡率、平均手术时间和住院时间、手术和医疗并发症以及非家庭出院。
结果
mFI 的增加与住院时间延长相关（mFI 0 组为 10.5±7.5 天，mFI≥3 组为 14.9±15.4 天；p<0.0001），死亡率较高（mFI 0 组为 1%，mFI≥3 组为 3.1%；p=0.02），再次手术（mFI 0 组为 15.4%，mFI≥3 组为 17.2%；p=0.002）和非计划再入院（mFI 0 组为 7.6%，mFI≥3 组为 18.8%；p=0.001）。并发症发生率更高（p<0.0001），mFI 评分较高的患者手术（p<0.002）和医疗（p<0.0001）并发症的发生率也更高。mFI 评分较高还预示着出院回家的可能性降低（p<0.0001）。多变量分析和按年龄分组的亚组分析结果仍然显著。
结论
mFI-5 是微血管头颈部重建风险的重要预测指标。按年龄分组的亚组分析突出了该工具可以帮助识别脆弱和因此处于风险中的年轻患者。通过术前适当识别虚弱患者，外科医生可以前瞻性地调整他们的手术和出院计划以及术后支持。
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