Department of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar; Teaching Hospital of the JLU Giessen, Wetzlar, Germany.
Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital Giessen, Giessen, Germany.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):3033-3042. doi: 10.1007/s00068-022-01878-2. Epub 2022 Feb 2.
Acute appendicitis in the elderly is becoming increasingly recognized for its often severe course. For various elective and urgent operations in older patients, frailty is a risk factor for poor outcomes. However, there is a lack of data on frailty in elderly patients with acute appendicitis.
Patients over 65 years old who underwent surgery for acute appendicitis in three hospitals between January 2015 and September 2020 were assessed with the Hospital Frailty Risk Score (HFRS) and the modified Frailty Index (mFI). Outcomes of interest, including morbidity, mortality, and length of stay, were recorded.
While frailty can be measured with both tests, the mFI has better applicability and takes significantly less time to implement compared to the HFRS (21.6 s vs. 80.3 s, p < 0.0001) while providing the same information value. Patients who exhibited frailty according to either assessment had a significantly higher rate of milder (OR 5.85/2.87, p < 0.0001/0.009) and serious (OR 4.92/3.61, p < 0.011/0.029) complications, more admissions to the intensive care unit (OR 5.16/7.36, p < 0.0001), and an almost doubled length of stay (12.7 days vs. 6.6 days, p < 0.005). Up to 31% of these patients required institutional care after discharge, which is significantly more than those without frailty (p < 0.0001). Furthermore, the mortality rate in frail patients was significantly elevated to 17%, compared to less than 1% in non-frail patients (p = 0.018).
In elderly patients, frailty is a significant risk factor for negative outcomes. Frailty can be assessed more quickly and reliably with the mFI compared to the HFRS.
老年人急性阑尾炎的病情常较为严重，其发病率正在逐渐升高。对于老年患者的各种择期和急诊手术，衰弱是不良预后的一个危险因素。然而，目前关于老年急性阑尾炎患者衰弱的数据还很缺乏。
评估了 2015 年 1 月至 2020 年 9 月期间在三所医院接受手术治疗的 65 岁以上的急性阑尾炎患者，使用医院衰弱风险评分（HFRS）和改良衰弱指数（mFI）进行评估。记录了感兴趣的结果，包括发病率、死亡率和住院时间。
虽然两种测试都可以衡量衰弱程度，但 mFI 比 HFRS 具有更好的适用性，实施时间也明显更短（21.6 秒 vs. 80.3 秒，p<0.0001），同时提供相同的信息价值。根据任何一种评估方法表现出衰弱的患者，其轻度（OR 5.85/2.87，p<0.0001/0.009）和严重（OR 4.92/3.61，p<0.011/0.029）并发症的发生率显著更高，需要入住重症监护病房（OR 5.16/7.36，p<0.0001）的比例更高，住院时间几乎延长了一倍（12.7 天 vs. 6.6 天，p<0.005）。高达 31%的这些患者在出院后需要机构护理，这明显高于没有衰弱的患者（p<0.0001）。此外，衰弱患者的死亡率显著升高至 17%，而无衰弱患者的死亡率不到 1%（p=0.018）。
在老年患者中，衰弱是不良预后的一个显著危险因素。与 HFRS 相比，mFI 可以更快速、更可靠地评估衰弱。
