开发和验证术前衰弱预测肝胰手术后依赖增加的风险分层工具。
Development and validation of risk stratification tool for prediction of increased dependence using preoperative frailty after hepatopancreatic surgery.
机构信息
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH; Pancreatic Multidisciplinary Clinic, Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, MD.
Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH; Department of Gastrointestinal Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
出版信息
Surgery. 2022 Aug;172(2):683-690. doi: 10.1016/j.surg.2022.03.021. Epub 2022 Apr 26.
BACKGROUND
Despite the known association between frailty and postoperative morbidity, the use of preoperative frailty in surgical practice remains limited. We sought to develop a risk tool to predict postoperative increase in functional dependence.
METHODS
Patients of ≥65 years in the National Surgical Quality Improvement Project database who had a primary hepatopancreatic surgery between 2015 and 2019 were used to identify predictors of increased dependence and development of a simplified tool to calculate the risk stratification score for increased discharge care level (https://ktsahara.shinyapps.io/care_discharge/).
RESULTS
Among 31,338 patients who underwent primary hepatopancreatic surgery, 4,259 (13.6%) had an increased level of care at discharge compared to their preadmission care. Patients with increased discharge care had a higher proportion of patients with a modified frailty index of at least 2 (n = 1496; 35.1%) compared with individuals with unchanged care (n = 6,760; 25.0%). In addition, 12.3% (n = 3,858) were discharged to a skilled nursing or rehabilitation facility. Of note, the odds of increased care at discharge were increased by 1.41 (95% confidence interval: 1.32-1.50), 1.11 (95% confidence interval :1.11-1.12), and 1.95 (95% confidence interval:1.86-2.04) times with every unit increase in modified frailty index, age beyond 65 years, and the number of in-hospital complications, respectively. Area under receiver operative curve for the parsimonious model used to develop the risk calculator was 0.7486 (95% confidence interval: 0.7405-0.7566) (all P < .001).
CONCLUSION
Approximately, 1 in 7 patients required an increased level of care at the time of discharge compared with their preadmission status. A simplified web-based risk tool can be used in clinical practice as a surgical decision aid in post-discharge planning after complex elective surgery.
背景
尽管虚弱与术后发病率之间存在已知的关联，但在外科实践中使用术前虚弱状况仍然有限。我们试图开发一种风险工具来预测术后功能依赖性增加。
方法
我们使用国家手术质量改进计划数据库中 2015 年至 2019 年间接受原发性肝胆胰手术的年龄≥65 岁的患者，确定增加依赖性的预测因素，并开发一种简化工具来计算增加出院护理水平的风险分层评分（https://ktsahara.shinyapps.io/care_discharge/）。
结果
在接受原发性肝胆胰手术的 31338 名患者中，有 4259 名（13.6%）与入院前护理相比，出院时的护理水平增加。与护理水平不变的患者（n=6760；25.0%）相比，出院护理水平增加的患者中，改良虚弱指数至少为 2 的患者比例更高（n=1496；35.1%）。此外，12.3%（n=3858）出院至康复护理机构。值得注意的是，出院时增加护理的可能性增加了 1.41（95%置信区间：1.32-1.50）、1.11（95%置信区间：1.11-1.12）和 1.95（95%置信区间：1.86-2.04）倍，这与改良虚弱指数每增加一个单位、年龄超过 65 岁以及住院并发症的数量有关。用于开发风险计算器的简约模型的接收者操作曲线下面积为 0.7486（95%置信区间：0.7405-0.7566）（均 P<0.001）。
结论
与入院前状态相比，大约每 7 名患者中就有 1 名在出院时需要增加护理水平。一种简化的基于网络的风险工具可在临床实践中作为复杂择期手术后出院计划的手术决策辅助工具。
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