McEvoy Lynette, Richter Matthew, Chen Tanghua, Le Ann, Wilson Carol, Marov Lynda, Gujraz Poumansing, Gray Leeanne, Mayahi-Neysi Mandana, Francis Nevenka, Mai Ha Thi, He Steven, Chróinín Danielle Ní, Frost Steven A
Liverpool Hospital, Liverpool, Australia.
The Tweed Hospital, Tweed Heads, Australia.
J Clin Nurs. 2023 Feb;32(3-4):477-484. doi: 10.1111/jocn.16259. Epub 2022 Feb 24.
While advances in healthcare mean people are living longer, increasing frailty is a potential consequence of this. The relationship between frailty among older surgical patients and hospital acquired adverse events has not been extensively explored. We sought to describe the relationship between increasing frailty among older surgical patients and the risk of hospital acquired adverse events.
We included consecutive surgical admissions among patients aged 70 years or more across the SWSLHD between January 2010 and December 2020. This study used routinely collected ICD-10-AM data, obtained from the government maintained Admitted Patient Data Collection. The relationships between cumulative frailty deficit items and risk of hospital acquired adverse events were assessed using Poisson regression modelling. This study followed the RECORD/STROBE guidelines.
During the study period, 44,721 (57% women) older adults were admitted, and 41% (25,306) were planned surgical admissions. The risk of all adverse events increased with increasing number of frailty deficit items, the highest deficit items group (4-12 deficit items) compared with the lowest deficit items group (0 or 1 deficit item): falls adjusted rate ratio (adj RR) = 15.3, (95% confidence interval (CI) 12.1, 19.42); pressure injury adj RR = 21.3 (95% CI 12.53, 36.16); delirium adj RR = 40.9 (95% CI 31.21, 53.55); pneumonia adj RR = 16.5 (95% CI 12.74, 21.27); thromboembolism adj RR = 17.3 (95% CI 4.4, 11.92); and hospital mortality adj RR = 6.2 (95% CI 5.18, 7.37).
The increase in number of cumulative frailty deficit items among older surgical patients was associated with a higher risk of adverse hospital events. The link offers an opportunity to clinical nursing professionals in the surgical setting, to develop and implement targeted models of care and ensure the best outcomes for frail older adults and their families.
虽然医疗保健的进步意味着人们寿命延长，但身体虚弱加剧是其潜在后果。老年外科患者的虚弱与医院获得性不良事件之间的关系尚未得到广泛探讨。我们试图描述老年外科患者身体虚弱加剧与医院获得性不良事件风险之间的关系。
我们纳入了2010年1月至2020年12月期间SWSLHD地区70岁及以上患者的连续手术入院病例。本研究使用了从政府维护的住院患者数据收集中获取的常规收集的ICD - 10 - AM数据。使用泊松回归模型评估累积虚弱缺陷项目与医院获得性不良事件风险之间的关系。本研究遵循RECORD/STROBE指南。
在研究期间，共收治了44,721名老年人（57%为女性），其中41%（25,306例）为计划性手术入院。所有不良事件的风险随着虚弱缺陷项目数量的增加而增加，最高缺陷项目组（4 - 12个缺陷项目）与最低缺陷项目组（0或1个缺陷项目）相比：跌倒调整率比（adj RR）= 15.3，（95%置信区间（CI）12.1, 19.42）；压力性损伤adj RR = 21.3（95% CI 12.53, 36.16）；谵妄adj RR = 40.9（95% CI 31.21, 53.55）；肺炎adj RR = 16.5（95% CI 12.74, 21.27）；血栓栓塞adj RR = 17.3（95% CI 4.4, 11.92）；医院死亡率adj RR = 6.2（95% CI 5.18, 7.37）。
老年外科患者累积虚弱缺陷项目数量的增加与不良医院事件的较高风险相关。这种关联为外科环境中的临床护理专业人员提供了一个机会，以制定和实施有针对性的护理模式，并确保体弱老年人及其家庭获得最佳结果。
