Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania.
Temple University Hospital, Department of Surgery, Philadelphia, Pennsylvania.
J Surg Res. 2022 Aug;276:83-91. doi: 10.1016/j.jss.2022.02.044. Epub 2022 Mar 24.
Thyroidectomy and parathyroidectomy are relatively safe procedures, with overall morbidity rates of 2%-5%. The increasing age is associated with higher likelihood of poor outcomes. The modified five-point frailty index (mFI-5) is associated with complications, but many surgeons are unfamiliar with mFI-5. We assessed the accuracy of the mFI-5 versus the commonly-used American Society of Anesthesiologists (ASA) classification to predict complications following thyroidectomy and parathyroidectomy.
Patients undergoing thyroidectomy or parathyroidectomy in 2015-2018 NSQIP datasets were identified. The mFI-5 scores were calculated by adding the number of the following comorbidities: congestive heart failure, hypertension requiring medication, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status. Receiver operating characteristics curves were plotted for 30-d mortality and serious morbidity (defined as deep surgical site infection, dehiscence, unplanned intubation, failure to wean from the ventilator 48-h postoperatively, acute renal failure, pneumonia, pulmonary embolism, myocardial infarction, cardiac arrest requiring cardiopulmonary resuscitation, sepsis, septic shock, cerebrovascular accident, or reoperation) using mFI-5 and ASA classification. Areas under these curves (AUC) were compared.
Ninety-two thousand, six hundred and ninety-one patients were studied. The mFI-5 and ASA were fair predictors of 30-d mortality (AUC 0.75 and 0.82, respectively) and good predictors of serious morbidity (AUC 0.61 and 0.64). After stratification by age, ASA was superior to mFI-5 in predicting mortality for patients aged 65, 70, 80 y, and older, for the entire population and for thyroidectomy and parathyroidectomy separately.
The ASA classification is a better predictor of mortality and serious morbidity than mFI-5 among patients undergoing thyroidectomy or parathyroidectomy and may be a better prognostic indicator to use when counseling patients before low-risk neck surgery.
甲状腺切除术和甲状旁腺切除术是相对安全的手术，总发病率为 2%-5%。年龄增长与不良预后的可能性增加相关。改良五分虚弱指数（mFI-5）与并发症相关，但许多外科医生对 mFI-5 不熟悉。我们评估了 mFI-5 与常用的美国麻醉医师协会（ASA）分类相比，预测甲状腺切除术和甲状旁腺切除术后并发症的准确性。
在 2015-2018 年 NSQIP 数据集中确定接受甲状腺切除术或甲状旁腺切除术的患者。mFI-5 评分通过以下合并症的数量相加计算：充血性心力衰竭、需要药物治疗的高血压、慢性阻塞性肺疾病、糖尿病和非独立的功能状态。绘制 30 天死亡率和严重发病率（定义为深部手术部位感染、裂开、术后 48 小时计划外插管、无法从呼吸机脱机、急性肾衰竭、肺炎、肺栓塞、心肌梗死、需要心肺复苏的心脏骤停、脓毒症、感染性休克、脑血管意外或再次手术）的 mFI-5 和 ASA 分类的 30 天死亡率和严重发病率（定义为深部手术部位感染、裂开、术后 48 小时计划外插管、无法从呼吸机脱机、急性肾衰竭、肺炎、肺栓塞、心肌梗死、心脏骤停需要心肺复苏、脓毒症、感染性休克、脑血管意外或再次手术）的接收器操作特征曲线。比较这些曲线下的面积（AUC）。
研究了 92691 名患者。mFI-5 和 ASA 对 30 天死亡率的预测均为中等（AUC 分别为 0.75 和 0.82），对严重发病率的预测均为良好（AUC 分别为 0.61 和 0.64）。按年龄分层后，ASA 在预测 65、70、80 岁及以上年龄组、全人群和甲状腺切除术和甲状旁腺切除术患者的死亡率方面优于 mFI-5。
在接受甲状腺切除术或甲状旁腺切除术的患者中，ASA 分类是死亡率和严重发病率的更好预测指标，而不是 mFI-5，并且在对低风险颈部手术前为患者提供咨询时，可能是更好的预后指标。
