Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China.
Department of Anesthesiology, the Fourth People's Hospital of Taizhou, 99 Gulou North Road, Hailing District, Taizhou City,, 225399, Jiangsu Province, China.
BMC Anesthesiol. 2023 Feb 28;23(1):63. doi: 10.1186/s12871-023-02024-0.
Frailty has been considered to be associated with major mortality and increased length of stay after cardiac surgery. This study aimed to explore the predictive potential of frailty assessment in the prognosis of elderly patients undergoing bypass surgery.
This study assessed the preoperative frailty according to the Fried's frailty phenotype, and included 150 frail and 150 non-frail elderly patients (≥ 65 y) who underwent bypass surgery. The present study evaluated the prognosis of elderly patients based on sequential organ failure assessment (SOFA) score, and collected clinical indicators to construct logistic regression models with the prognosis as the dependent variable, to explore the potential predictive ability of preoperative frailty. Moreover, this study focused on the complications and analyzed the relationship between preoperative frailty and postoperative complications.
In the present study, 244 patients were divided into the favorable prognosis group and 56 patients were divided into the unfavorable prognosis group. Logistic regression analysis showed that increased myoglobin and high cardiac function classification were independent risk factors for unfavorable prognosis in elderly patients undergoing bypass surgery. The discrimination of the clinical prediction model was determined by the receiver operating characteristic (ROC) curve, and the area under curve (AUC) was 0.928. After adding preoperative frailty assessment, the AUC was improved to 0.939. This study found a significant correlation between preoperative frailty and postoperative complications, mainly in the circulatory system.
Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting. According to our study, frailty assessment and appropriate intervention before bypass surgery may be beneficial to the enhanced recovery after cardiac surgery.
The clinical study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (2021-SR-393). All patients signed an informed consent form.
衰弱与心脏手术后的主要死亡率和住院时间延长有关。本研究旨在探讨衰弱评估对行旁路手术的老年患者预后的预测潜力。
本研究根据 Fried 衰弱表型评估术前衰弱，并纳入 150 例衰弱和 150 例非衰弱（≥65 岁）老年患者行旁路手术。本研究根据序贯器官衰竭评估（SOFA）评分评估老年患者的预后，并收集临床指标构建以预后为因变量的逻辑回归模型，探讨术前衰弱的潜在预测能力。此外，本研究重点关注并发症，并分析术前衰弱与术后并发症的关系。
本研究中，244 例患者分为预后良好组，56 例患者分为预后不良组。Logistic 回归分析显示，肌红蛋白升高和心功能分级高是老年患者旁路手术后预后不良的独立危险因素。临床预测模型的判别通过受试者工作特征（ROC）曲线确定，曲线下面积（AUC）为 0.928。加入术前衰弱评估后，AUC 提高至 0.939。本研究发现术前衰弱与术后并发症存在显著相关性，主要发生在循环系统。
术前衰弱评估可作为预测老年患者冠状动脉旁路移植术预后的指标。根据我们的研究，旁路手术前的衰弱评估和适当干预可能有益于心脏手术后的快速康复。
该临床研究得到南京医科大学第一附属医院医学伦理委员会的批准（2021-SR-393）。所有患者均签署了知情同意书。
