Gill Thomas M, Murphy Terrence E, Gahbauer Evelyne A, Leo-Summers Linda, Becher Robert D
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
J Am Geriatr Soc. 2022 May;70(5):1471-1480. doi: 10.1111/jgs.17693. Epub 2022 Feb 24.
Strong epidemiologic evidence linking indicators of geriatric vulnerability to long-term functional outcomes after major surgery is lacking. The objective of this study was to evaluate the association between geriatric vulnerability and the burden of disability after hospital discharge for major surgery.
From a prospective longitudinal study of 754 nondisabled community-living persons, aged 70 years or older, 327 admissions for major surgery were identified from 247 participants who were discharged from the hospital from March 1997 to December 2017. The indicators of geriatric vulnerability were ascertained immediately prior to the major surgery or during the prior comprehensive assessment, which was completed every 18 months. Disability in 13 essential, instrumental and mobility activities was assessed each month.
The burden of disability over the 6 months after major surgery was considerably greater for non-elective than elective surgery. In multivariable analysis, 10 factors were independently associated with disability burden: age 85 years or older, female sex, Black race or Hispanic ethnicity, neighborhood disadvantage, multimorbidity, frailty, one or more disabilities, low functional self-efficacy, smoking, and obesity. The burden of disability increased with each additional vulnerability factor, with mean values (credible intervals) increasing from 1.6 (1.4-1.9) disabilities for 0-1 vulnerability factors to 6.6 (6.0-7.2) disabilities for 7 or more vulnerability factors. The corresponding values were 1.2 (0.9-1.5) and 5.9 (5.0-6.7) disabilities for elective surgery and 2.6 (2.1-3.1) and 8.2 (7.3-9.2) disabilities for non-elective surgery.
The burden of disability after hospital discharge for major surgery increases progressively as the number of geriatric vulnerability factors increases. These factors can be used to identify older persons who are particularly susceptible to poor functional outcomes after major surgery, and a subset may be amenable to intervention, including frailty, low functional self-efficacy, smoking, and obesity.
缺乏有力的流行病学证据来证明老年脆弱性指标与大手术后长期功能结局之间的联系。本研究的目的是评估老年脆弱性与大手术后出院后残疾负担之间的关联。
在一项对754名70岁及以上非残疾社区居民的前瞻性纵向研究中，从1997年3月至2017年12月出院的247名参与者中确定了327例大手术入院病例。老年脆弱性指标在大手术前或之前每18个月完成一次的全面评估期间立即确定。每月评估13项基本、工具性和移动性活动中的残疾情况。
非择期手术大手术后6个月的残疾负担比择期手术大得多。在多变量分析中，10个因素与残疾负担独立相关：85岁及以上年龄、女性、黑人种族或西班牙裔、邻里劣势、多种合并症、虚弱、一种或多种残疾、功能自我效能低、吸烟和肥胖。残疾负担随着每个额外的脆弱性因素而增加，平均值（可信区间）从0 - 1个脆弱性因素的1.6（1.4 - 1.9）项残疾增加到7个或更多脆弱性因素的6.6（6.0 - 7.2）项残疾。择期手术的相应值为1.2（0.9 - 1.5）和5.9（5.0 - 6.7）项残疾，非择期手术为2.6（2.1 - 3.1）和8.2（7.3 - 9.2）项残疾。
随着老年脆弱性因素数量增加，大手术后出院后的残疾负担逐渐增加。这些因素可用于识别大手术后功能结局特别容易不佳的老年人，并且其中一部分人可能适合进行干预，包括虚弱、功能自我效能低、吸烟和肥胖。
