Concord Repatriation General Hospital, Sydney, NSW, Australia.
Western Health, Melbourne, VIC, Australia.
ANZ J Surg. 2022 Sep;92(9):2305-2311. doi: 10.1111/ans.17810. Epub 2022 Jun 8.
Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision-making about vascular surgery in the resource constrained COVID-19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes.
The COVID-19 Vascular Service in Australia (COVER-AU) prospective cohort study evaluates 30-day and six-month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March-July 2020. The primary outcome was mortality, with secondary outcomes procedure-related outcomes and hospital utilization. Frailty was assessed using the nine-point visual Clinical Frailty Score, scores of 5 or more considered frail.
Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% (n = 20) and 5.9% (n = 35) respectively with no significant difference between frail and non-frail patients (OR 1.68, 95%CI 0.79-3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non-frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non-frail patients, after adjustment (OR 2.01; 95% CI 1.17-3.78), driven by a high rate of amputation during the period of reduced surgical activity.
Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.
衰弱预测血管手术患者围手术期不良结局和死亡率增加。衰弱评估是一种潜在的工具，可以在资源有限的 COVID-19 大流行环境中为血管手术的资源分配和共享决策提供信息。这项队列研究描述了血管手术患者衰弱的发生率，以及衰弱与死亡率和围手术期结局之间的关系。
澳大利亚 COVID-19 血管服务（COVER-AU）前瞻性队列研究评估了 2020 年 3 月至 7 月期间 11 个澳大利亚血管单位连续进行血管手术的患者的 30 天和 6 个月结局。主要结局是死亡率，次要结局是手术相关结局和医院利用情况。衰弱使用 9 分视觉临床衰弱评分进行评估，得分 5 分或以上被认为衰弱。
在纳入的 917 名患者中，203 名患者衰弱（22.1%）。30 天和 6 个月的死亡率分别为 2.0%（n=20）和 5.9%（n=35），衰弱患者与非衰弱患者之间无显著差异（OR 1.68，95%CI 0.79-3.54）。然而，与非衰弱患者相比，衰弱患者住院时间更长，围手术期并发症更多，更有可能再次入院或再次手术。6 个月时，衰弱患者发生主要截肢的可能性是非衰弱患者的两倍，调整后（OR 2.01；95%CI 1.17-3.78），这主要是由于手术活动减少期间截肢率较高。
我们的研究结果强调，年龄较大、衰弱的患者经历了潜在可预防的不良结局，需要有针对性的干预措施来优化护理，特别是在医疗保健压力大的时候。
