Hori Kentaro, Usuba Koyo, Sakuyama Akihiro, Adachi Yuichi, Hirakawa Kotaro, Nakayama Atsuko, Nagayama Masatoshi, Shimokawa Tomoki, Takanashi Shuichiro, Isobe Mitsuaki
Department of Rehabilitation, Sakakibara Heart Institute Tokyo Japan.
Research Centre for Evaluating Children's Health Outcomes (ECHO), Laurentian University Sudbury, ON Canada.
Circ Rep. 2021 Jul 22;3(8):423-430. doi: 10.1253/circrep.CR-21-0057. eCollection 2021 Aug 10.
Hospitalization-associated disability (HAD) is associated with prolonged functional decline and increased mortality after discharge. Therefore, we examined the incidence and risk factors associated with HAD in elderly patients undergoing cardiac surgery in Japan. We retrospectively examined 2,262 elderly patients who underwent elective cardiac surgery at Sakakibara Heart Institute. HAD was defined as a functional decline between time of admission and discharge measured by the Barthel Index. We analyzed clinical characteristics using machine learning algorithms to identify the risk factors associated with HAD. After excluding 203 patients, 2,059 patients remained, of whom 108 (5.2%) developed HAD after cardiac surgery. The risk factors identified were age, serum albumin concentration, estimated glomerular filtration rate, Revised Hasegawa's Dementia Scale, N-terminal pro B-type natriuretic peptide, vital capacity, preoperative Short Physical Performance Battery (SPPB) score, operation times, cardiopulmonary bypass times, ventilator times, length of postoperative intensive care unit stay, and postoperative ambulation start day. The highest incidence of HAD was found in patients with an SPPB score ≤9 and in those who started ambulation >6 days after surgery (76.9%). Several risk factors for HAD are components of frailty, suggesting that preoperative rehabilitation to reduce the risk of HAD is feasible. Furthermore, the association between HAD and a delayed start of ambulation reaffirms the importance of early mobilization and rehabilitation.
住院相关残疾（HAD）与出院后功能长期下降和死亡率增加相关。因此，我们研究了日本接受心脏手术的老年患者中HAD的发生率及相关危险因素。我们回顾性研究了在栃木心脏研究所接受择期心脏手术的2262例老年患者。HAD定义为入院时与出院时通过巴氏指数测量的功能下降。我们使用机器学习算法分析临床特征，以确定与HAD相关的危险因素。排除203例患者后，剩余2059例患者，其中108例（5.2%）在心脏手术后发生了HAD。确定的危险因素包括年龄、血清白蛋白浓度、估计肾小球滤过率、修订版长谷川痴呆量表、N末端B型利钠肽原、肺活量、术前简易体能状况量表（SPPB）评分、手术时间、体外循环时间、呼吸机使用时间、术后重症监护病房住院时间以及术后开始行走的天数。HAD发生率最高的是SPPB评分≤9的患者以及术后>6天开始行走的患者（76.9%）。HAD的几个危险因素是衰弱的组成部分，这表明术前康复以降低HAD风险是可行的。此外，HAD与行走开始延迟之间的关联再次强调了早期活动和康复的重要性。
