风险分析指数评估的衰弱情况可预测难治性癫痫患者切除术后非居家出院和死亡率：2012 年至 2020 年前瞻性手术登记处 1236 例患者的分析。
Frailty Measured by the Risk Analysis Index Predicts Nonhome Discharge and Mortality After Resection in Refractory Epilepsy: Analysis of 1236 Patients From a Prospective Surgical Registry, 2012 to 2020.
机构信息
Texas Tech University Health Sciences Center School of Medicine, El Paso, Texas, USA.
Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
出版信息
Neurosurgery. 2023 Aug 1;93(2):267-273. doi: 10.1227/neu.0000000000002439. Epub 2023 Feb 28.
BACKGROUND
Risk stratification of epilepsy surgery patients remains difficult. The Risk Analysis Index (RAI) is a frailty measurement that augments preoperative risk stratification.
OBJECTIVE
To evaluate RAI's discriminative threshold for nonhome discharge disposition (NHD) and mortality (or discharge to hospice within 30 days of operation) in epilepsy surgery patients.
METHODS
Patients were queried from the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020) using diagnosis/procedure codes. Linear-by-linear trend tests assessed RAI's relationship with NHD and mortality. Discriminatory accuracy was assessed by C-statistics (95% CI) in receiver operating characteristic curve analysis.
RESULTS
Epilepsy resections (N = 1236) were grouped into temporal lobe (60.4%, N = 747) and nontemporal lobe (39.6%, N = 489) procedures. Patients were stratified by RAI tier: 76.5% robust (RAI 0-20), 16.2% normal (RAI 21-30), 6.6% frail (RAI 31-40), and 0.8% severely frail (RAI 41 and above). The NHD rate was 18.0% (N = 222) and positively associated with increasing RAI tier: 12.5% robust, 34.0% normal, 38.3% frail, and 50.0% severely frail ( P < .001). RAI had robust predictive discrimination for NHD in overall cohort (C-statistic 0.71), temporal lobe (C-statistic 0.70), and nontemporal lobe (C-statistic 0.71) cohorts. The mortality rate was 2.7% (N = 33) and significantly associated with RAI frailty: 1.1% robust, 8.0% normal, 6.2% frail, and 20.0% severely frail ( P < .001). RAI had excellent predictive discrimination for mortality in overall cohort (C-statistic 0.78), temporal lobe (C-statistic 0.80), and nontemporal lobe (C-statistic 0.74) cohorts.
CONCLUSION
The RAI frailty score predicts mortality and NHD after epilepsy surgery. This is accomplished with a user-friendly calculator: https://nsgyfrailtyoutcomeslab.shinyapps.io/epilepsy/ .
背景
癫痫手术患者的风险分层仍然很困难。风险分析指数（RAI）是一种衰弱测量指标，可增强术前风险分层。
目的
评估 RAI 对癫痫手术患者非家庭出院处置（NHD）和死亡率（或术后 30 天内出院至临终关怀）的判别阈值。
方法
使用诊断/手术代码从美国外科医师学院-国家手术质量改进计划数据库（2012-2020 年）中查询患者。线性-线性趋势检验评估了 RAI 与 NHD 和死亡率的关系。通过受试者工作特征曲线分析中的 C 统计量（95%置信区间）评估判别准确性。
结果
癫痫切除术（N=1236）分为颞叶（60.4%，N=747）和非颞叶（39.6%，N=489）手术。根据 RAI 分层：76.5%健壮（RAI 0-20），16.2%正常（RAI 21-30），6.6%虚弱（RAI 31-40），0.8%严重虚弱（RAI 41 及以上）。NHD 发生率为 18.0%（N=222），与 RAI 分层呈正相关：健壮 12.5%，正常 34.0%，虚弱 38.3%，严重虚弱 50.0%（P<0.001）。RAI 在总体队列（C 统计量 0.71）、颞叶（C 统计量 0.70）和非颞叶（C 统计量 0.71）队列中对 NHD 具有可靠的预测判别能力。死亡率为 2.7%（N=33），与 RAI 虚弱显著相关：健壮 1.1%，正常 8.0%，虚弱 6.2%，严重虚弱 20.0%（P<0.001）。RAI 在总体队列（C 统计量 0.78）、颞叶（C 统计量 0.80）和非颞叶（C 统计量 0.74）队列中对死亡率具有优异的预测判别能力。
结论
RAI 衰弱评分可预测癫痫手术后的死亡率和 NHD。这可以通过一个用户友好的计算器来实现：https://nsgyfrailtyoutcomeslab.shinyapps.io/epilepsy/。
Zotero 插件