Zhang Xiao-Ming, Wu Xin-Juan, Cao Jing, Guo Na, Bo Hai-Xin, Ma Yu-Fen, Jiao Jing, Zhu Chen
Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
Front Med (Lausanne). 2022 Jun 28;9:896451. doi: 10.3389/fmed.2022.896451. eCollection 2022.
Identifying a high-risk group of older people before surgical procedures is very important. The study aimed to explore the association between the age-adjusted Charlson comorbidity index (ACCI) and all-cause mortality and readmission among older Chinese surgical patients (age ≥65 years).
A large-scale cohort study was performed in 25 general public hospitals from six different geographic regions of China. Trained registered nurses gathered data on clinical and sociodemographic characteristics. All-cause mortality was recorded when patients died during hospitalization or during the 90-day follow-up period. Readmission was also tracked from hospital discharge to the 90-day follow-up. The ACCI, in assessing comorbidities, was categorized into two groups (≥5 vs. <5). A multiple regression model was used to examine the association between the ACCI and all-cause mortality and readmission.
There were 3,911 older surgical patients (mean = 72.46, SD = 6.22) in our study, with 1,934 (49.45%) males. The average ACCI score was 4.77 (SD = 1.99), and all-cause mortality was 2.51% (high ACCI = 5.06% vs. low ACCI = 0.66%, < 0.001). After controlling for all potential confounders, the ACCI score was an independent risk factor for 90-day hospital readmission (OR = 1.18, 95% CI: 1.14, 1.23) and 90-day all-cause mortality (OR = 1.26, 95% CI: 1.16-1.36). Furthermore, older surgical patients with a high ACCI (≥5) had an increased risk of all-cause mortality (OR = 6.13, 95% CI: 3.17, 11.85) and readmission (OR = 2.13, 95% CI: 1.78, 2.56) compared to those with a low ACCI (<5). The discrimination performance of the ACCI was moderate for mortality (AUC:0.758, 95% CI: 0.715-0.80; specificity = 0.591, sensitivity = 0.846) but poor for readmission (AUC: 0.627, 95% CI: 0.605-0.648; specificity = 0.620; sensitivity = 0.590).
The ACCI is an independent risk factor for all-cause mortality and hospital readmission among older Chinese surgical patients and could be a potential risk assessment tool to stratify high-risk older patients for surgical procedures.
在手术前识别老年高危人群非常重要。本研究旨在探讨年龄校正的Charlson合并症指数（ACCI）与中国老年手术患者（年龄≥65岁）的全因死亡率和再入院率之间的关联。
在中国六个不同地理区域的25家综合公立医院进行了一项大规模队列研究。经过培训的注册护士收集了临床和社会人口学特征数据。记录患者在住院期间或90天随访期内死亡的全因死亡率。从出院到90天随访也追踪再入院情况。在评估合并症时，ACCI被分为两组（≥5 vs. <5）。使用多元回归模型来检验ACCI与全因死亡率和再入院率之间的关联。
我们的研究中有3911名老年手术患者（平均年龄 = 72.46，标准差 = 6.22），其中男性1934名（49.45%）。ACCI平均得分为4.77（标准差 = 1.99），全因死亡率为2.51%（高ACCI = 5.06% vs. 低ACCI = 0.66%，<0.001）。在控制所有潜在混杂因素后，ACCI得分是90天医院再入院（OR = 1.18，95%CI：1.14，1.23）和90天全因死亡率（OR = 1.26，95%CI：1.16 - 1.36）的独立危险因素。此外，与低ACCI（<5）的老年手术患者相比，高ACCI（≥5）的患者全因死亡率（OR = 6.13，95%CI：3.17，11.85）和再入院率（OR = 2.13，95%CI：1.78，2.56）增加。ACCI对死亡率的判别性能中等（AUC：0.758，95%CI：0.715 - 0.80；特异性 = 0.591，敏感性 = 0.846），但对再入院的判别性能较差（AUC：0.627，95%CI：0.605 - 0.648；特异性 = 0.620；敏感性 = 0.590）。
ACCI是中国老年手术患者全因死亡率和医院再入院的独立危险因素，可能是一种潜在的风险评估工具，用于对老年高危患者进行手术分层。
