Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Gerontology. 2022;68(11):1276-1284. doi: 10.1159/000524760. Epub 2022 May 16.
Predicting preoperative frailty risk in emergency surgery is difficult with limited information because preoperative evaluation is not commonly performed properly. A recent study attempted to predict preoperative frailty risk using only diagnostic and surgical codes that can be extracted from the electronic medical records system.
This study aimed to validate whether the prediction model of preoperative frailty risk presented in the previous study is well applied to other medical hospitals' data.
This is a retrospective cohort study including 1,557 patients (≥75 years old) who were admitted to a single institution for emergency operations between January 1, 2010, and December 31, 2019, for study analysis. The Charlson comorbidity index, Hospital Frailty Risk Score, and the recently developed Operation Frailty Risk Score (OFRS) were calculated using the patient's diagnostic and operation codes. The predictive performances of these calculated risk scores and the American Society of Anesthesiologists-Physical Status classification for postoperative 90-day mortality were compared by using the receiver operating characteristic curve analysis.
The predictive performance of the OFRS, Charlson comorbidity index, American Society of Anesthesiologists-Physical Status, and Hospital Frailty Risk Score for postoperative 90-day mortality was 0.81, 0.630, 0.699, and 0.549 on a c-statistics basis, respectively.
The OFRS using diagnostic and operation codes may show the best predictive performance for 90-day mortality compared to other risk scores, and it can be the clinically applicable model to evaluate the preoperative frailty risk in elderly patients undergoing emergency surgery.
由于术前评估通常做得不够规范，因此可用的信息有限，难以预测急诊手术的术前虚弱风险。最近的一项研究试图仅使用可从电子病历系统中提取的诊断和手术代码来预测术前虚弱风险。
本研究旨在验证之前研究中提出的术前虚弱风险预测模型是否可以很好地应用于其他医疗机构的数据。
这是一项回顾性队列研究，纳入了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间因急诊手术入住一家医疗机构的 1557 名（≥75 岁）患者进行研究分析。使用患者的诊断和手术代码计算 Charlson 合并症指数、医院虚弱风险评分和最近开发的手术虚弱风险评分（OFRS）。通过接受者操作特征曲线分析比较这些计算出的风险评分和美国麻醉医师协会身体状况分类对术后 90 天死亡率的预测性能。
OFRS、Charlson 合并症指数、美国麻醉医师协会身体状况和医院虚弱风险评分对术后 90 天死亡率的预测性能基于 C 统计量分别为 0.81、0.630、0.699 和 0.549。
与其他风险评分相比，使用诊断和手术代码的 OFRS 可能对 90 天死亡率显示出最佳的预测性能，并且它可能是评估接受急诊手术的老年患者术前虚弱风险的临床适用模型。
