Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
J Thorac Cardiovasc Surg. 2023 Sep;166(3):870-878.e6. doi: 10.1016/j.jtcvs.2022.01.032. Epub 2022 Feb 3.
Frailty increases risk for morbidity and mortality after cardiac surgery. Its influence on functional outcome is largely unknown. We studied the association of frailty with health-related quality of life and disability after cardiac surgery.
A prospective 2-center observational cohort of 555 patients aged 70 years or more undergoing cardiac surgery. A comprehensive frailty assessment was performed before surgery based on 11 individual assessments in physical, mental, and social domains. Frailty was defined as at least 1 positive test in each domain. The primary outcome was health-related quality of life over 1 year, and the secondary outcomes were severe in-hospital complications and disability over 1 year. Adverse functional outcome was defined as the composite of a decreased health-related quality of life and disability.
Physical frailty was most common (91%) compared with mental (39%) or social frailty (42%). Adverse functional outcome occurred in 257 patients (46%) and consisted of decreased physical health-related quality of life in 134 (24%), decreased mental health-related quality of life in 141 (25%), and disability in 120 (22%). Frailty was more common in patients with adverse functional outcome (29%) compared with patients without adverse functional outcome (16%, P < .001). Poor mobility, malnutrition, and polypharmacy were associated with a decreased health-related quality of life over time, whereas impaired physical functioning and higher self-rated health were related to increased health-related quality of life. Disability after cardiac surgery was associated with poor mobility, polypharmacy, dependent living, living alone, and lower self-rated mental health before surgery.
Mobility, nutrition, medication use, physical functioning, and self-rated health before surgery are associated with health-related quality of life in elderly patients 1 year after cardiac surgery.
虚弱增加了心脏手术后发病率和死亡率的风险。其对功能结果的影响在很大程度上尚不清楚。我们研究了虚弱与心脏手术后健康相关的生活质量和残疾的关系。
这是一项前瞻性的 2 中心观察性队列研究，共纳入 555 名年龄在 70 岁及以上接受心脏手术的患者。在手术前，根据身体、心理和社会领域的 11 项单独评估，进行全面的虚弱评估。虚弱被定义为每个领域至少有 1 项阳性检查。主要结局是 1 年后的健康相关生活质量，次要结局是 1 年内的严重院内并发症和残疾。不良功能结局定义为健康相关生活质量下降和残疾的综合表现。
与精神（39%）或社会（42%）虚弱相比，身体虚弱最为常见（91%）。257 名患者（46%）出现不良功能结局，包括身体健康相关生活质量下降 134 例（24%）、心理健康相关生活质量下降 141 例（25%）和残疾 120 例（22%）。与无不良功能结局的患者（16%，P < 0.001）相比，有不良功能结局的患者更常见虚弱（29%）。行动不便、营养不良和多药治疗与健康相关生活质量随时间下降相关，而身体机能受损和自我评估健康状况较好与健康相关生活质量的提高相关。心脏手术后的残疾与术前行动不便、多药治疗、依赖生活、独居和自我评估心理健康状况较差有关。
术前的移动能力、营养状况、用药情况、身体机能和自我评估的心理健康状况与老年患者心脏手术后 1 年的健康相关生活质量有关。
