术前衰弱与成人心脏手术后结局的关系：一项前瞻性队列研究。
Association between preoperative frailty and outcomes among adults undergoing cardiac surgery: a prospective cohort study.
机构信息
Department of Critical Care Medicine (Montgomery, Zibdawi, Bagshaw), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Department of Critical Care Medicine (Stelfox), Cumming School of Medicine, and Department of Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; Faculty of Nursing and School of Public Health (Norris, Bagshaw), University of Alberta; Strategic Clinical Networks (Norris, Bagshaw), Alberta Health Services; Division of Geriatric Medicine (Rolfson), Department of Medicine, and Division of Cardiac Surgery, (Meyer) Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.
出版信息
CMAJ Open. 2021 Jul 20;9(3):E777-E787. doi: 10.9778/cmajo.20200034. Print 2021 Jul-Sep.
BACKGROUND
The identification of frailty before complex and invasive procedures may have relevance for prognostic and recovery purposes, to optimally inform patients, caregivers and clinicians about perioperative risk and postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery.
METHODS
A prospective cohort of patients aged 50 years and older referred for nonemergent cardiac surgery in Alberta, Canada, from November 2011 to March 2014 were screened preoperatively for frailty, defined as a Clinical Frailty Scale (CFS) score of 5 or greater. Postoperatively, patients were followed by telephone to assess CFS score, health services use and vital status. The primary outcome was all-cause hospital mortality. Secondary outcomes included health services use, hospital discharge disposition, 1-year health-related quality of life and all-cause 5-year mortality.
RESULTS
The cohort ( = 529) had a mean age of 67 (standard deviation [SD] 9) years; 25.9% were female, and the prevalence of frailty was 9.6% ( = 51; 95% confidence interval [CI] 7.3%-12.5%). Frail patients were older (median age 75, interquartile range [IQR] 65-80 v. 67, IQR 60-73, yr; < 0.001), were more likely to be female (51.0% v. 23.2%; < 0.001), had a higher mean EuroSCORE II (8, SD 3 v. 5, SD 3; < 0.001) and received combined coronary artery bypass grafting and valve procedures more frequently (29.4% v. 15.9%; = 0.02) than nonfrail patients. Postoperatively, frail patients had a longer median duration of stay in the cardiovascular intensive care unit (median difference 2.2, 95% CI 1.60-2.79) and hospital (median difference 9.3, 95% CI 8.2-10.3). Hospital mortality was 9.8% among frail patients and 1.0% among nonfrail patients (adjusted hazard ratio 3.84, 95% CI 0.90-16.34).
INTERPRETATION
Preoperative frailty was present in 10% of patients and was associated with a higher risk of morbidity and greater health services use. Preoperative frailty has important implications for the postoperative clinical course and resource utilization of patients undergoing cardiac surgery.
背景
在进行复杂和侵入性手术之前识别脆弱性可能与预后和恢复有关，以便为患者、护理人员和临床医生提供最佳的围手术期风险和术后护理需求信息。本研究的目的是评估脆弱性的发生率，并描述接受非紧急心脏手术患者的相关临床过程和结局。
方法
2011 年 11 月至 2014 年 3 月，加拿大艾伯塔省对 50 岁及以上接受非紧急心脏手术的患者进行前瞻性队列研究，在术前用临床虚弱量表（CFS）筛查脆弱性，CFS 评分≥5 分定义为脆弱性。术后通过电话对患者进行随访，评估 CFS 评分、卫生服务使用情况和生存状况。主要结局是全因住院死亡率。次要结局包括卫生服务使用情况、出院去向、1 年健康相关生活质量和全因 5 年死亡率。
结果
队列（=529）的平均年龄为 67（标准差[SD]9）岁；25.9%为女性，脆弱性的发生率为 9.6%（=51；95%置信区间[CI]7.3%-12.5%）。虚弱患者年龄更大（中位数 75，四分位距[IQR]65-80 v. 67，IQR 60-73，岁；<0.001），女性更多（51.0% v. 23.2%；<0.001），EuroSCORE II 平均值更高（8，SD 3 v. 5，SD 3；<0.001），更常接受冠状动脉旁路移植术和瓣膜联合手术（29.4% v. 15.9%；=0.02）。术后，虚弱患者心血管重症监护病房（中位差异 2.2，95%CI 1.60-2.79）和医院（中位差异 9.3，95%CI 8.2-10.3）的中位住院时间更长。虚弱患者的住院死亡率为 9.8%，非虚弱患者的住院死亡率为 1.0%（调整后的危险比 3.84，95%CI 0.90-16.34）。
解释
术前虚弱的发生率为 10%，与更高的发病率和更多的卫生服务使用相关。术前虚弱对接受心脏手术患者的术后临床过程和资源利用有重要影响。
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