Departments of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
Radiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.
Anesthesiology. 2022 Feb 1;136(2):268-278. doi: 10.1097/ALN.0000000000004064.
Frailty is increasingly being recognized as a public health issue, straining healthcare resources and increasing costs to care for these patients. Frailty is the decline in physical and cognitive reserves leading to increased vulnerability to stressors such as surgery or disease states. The goal of this pilot diagnostic accuracy study was to identify whether point-of-care ultrasound measurements of the quadriceps and rectus femoris muscles can be used to discriminate between frail and not-frail patients and predict postoperative outcomes. This study hypothesized that ultrasound could discriminate between frail and not-frail patients before surgery.
Preoperative ultrasound measurements of the quadriceps and rectus femoris were obtained in patients with previous computed tomography scans. Using the computed tomography scans, psoas muscle area was measured in all patients for comparative purposes. Frailty was identified using the Fried phenotype assessment. Postoperative outcomes included unplanned intensive care unit admission, delirium, intensive care unit length of stay, hospital length of stay, unplanned skilled nursing facility admission, rehospitalization, falls within 30 days, and all-cause 30-day and 1-yr mortality.
A total of 32 patients and 20 healthy volunteers were included. Frailty was identified in 18 of the 32 patients. Receiver operating characteristic curve analysis showed that quadriceps depth and psoas muscle area are able to identify frailty (area under the curve-receiver operating characteristic, 0.80 [95% CI, 0.64 to 0.97] and 0.88 [95% CI, 0.76 to 1.00], respectively), whereas the cross-sectional area of the rectus femoris is less promising (area under the curve-receiver operating characteristic, 0.70 [95% CI, 0.49 to 0.91]). Quadriceps depth was also associated with unplanned postoperative skilled nursing facility discharge disposition (area under the curve 0.81 [95% CI, 0.61 to 1.00]) and delirium (area under the curve 0.89 [95% CI, 0.77 to 1.00]).
Similar to computed tomography measurements of psoas muscle area, preoperative ultrasound measurements of quadriceps depth shows promise in discriminating between frail and not-frail patients before surgery. It was also associated with skilled nursing facility admission and postoperative delirium.
衰弱日益被视为公共卫生问题，给医疗保健资源带来压力，并增加了对这些患者的护理成本。衰弱是指身体和认知储备的下降，导致对手术或疾病状态等压力源的易感性增加。本先导诊断准确性研究的目的是确定在接受手术之前，使用即时超声测量股四头肌和股直肌是否可以用于区分虚弱和非虚弱患者，并预测术后结果。本研究假设超声可以在手术前区分虚弱和非虚弱患者。
对接受过计算机断层扫描的患者进行术前股四头肌和股直肌的即时超声测量。使用计算机断层扫描测量所有患者的腰大肌面积，作为比较目的。采用 Fried 表型评估确定衰弱情况。术后结果包括计划外入住重症监护病房、谵妄、重症监护病房住院时间、医院住院时间、计划外入住熟练护理设施、再入院、30 天内跌倒和全因 30 天和 1 年死亡率。
共纳入 32 例患者和 20 例健康志愿者。32 例患者中 18 例为衰弱。受试者工作特征曲线分析显示，股四头肌深度和腰大肌面积可识别衰弱（曲线下面积-受试者工作特征，0.80[95%置信区间，0.64 至 0.97]和 0.88[95%置信区间，0.76 至 1.00]），而股直肌的横截面积则不太理想（曲线下面积-受试者工作特征，0.70[95%置信区间，0.49 至 0.91]）。股四头肌深度也与术后计划入住熟练护理设施有关（曲线下面积 0.81[95%置信区间，0.61 至 1.00]）和谵妄（曲线下面积 0.89[95%置信区间，0.77 至 1.00]）。
与腰大肌面积的计算机断层扫描测量类似，股四头肌深度的术前超声测量在手术前区分虚弱和非虚弱患者方面显示出了一定的潜力。它还与熟练护理设施的入住和术后谵妄有关。
