Levine Monica D, Felix Ashley S, Meade Caitlin E, Bixel Kristin L, Chambers Laura M
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA.
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
Int J Gynecol Cancer. 2023 Apr 3;33(4):465-472. doi: 10.1136/ijgc-2022-004175.
To determine whether frailty is associated with post-operative complications following surgery for vulvar cancer.
This retrospective study used a multi-institutional dataset from the National Surgical Quality Improvement Program (NSQIP) database (2014-2020) to analyze the relationship between frailty, procedure type, and post-operative complications. Frailty was determined using the modified frailty index-5 (mFI-5). Univariate and multivariable-adjusted logistic regression analyses were performed.
Of 886 women, 49.9% underwent radical vulvectomy alone, and 19.5% and 30.6% underwent concurrent unilateral or bilateral inguinofemoral lymphadenectomy, respectively; 24.5% had mFI ≥2 and were considered frail. Compared with non-frail women, those with an mFI ≥2 were more likely to have an unplanned readmission (12.9% vs 7.8%, p=0.02), wound disruption (8.3% vs 4.2%, p=0.02), and deep surgical site infection (3.7% vs 1.4%, p=0.04). On multivariable-adjusted models, frailty was a significant predictor for minor (OR 1.58, 95% CI 1.09 to 2.30) and any complications (OR 1.46, 95% CI 1.02 to 2.08). Specifically, for radical vulvectomy with bilateral inguinofemoral lymphadenectomy, frailty was significantly associated with major (OR 2.13, 95% CI 1.03 to 4.40) and any complications (OR 2.10, 95% CI 1.14 to 3.87).
In this analysis of the NSQIP database, nearly 25% of women undergoing radical vulvectomy were considered frail. Frailty was associated with increased post-operative complications, especially in women concurrently undergoing bilateral inguinofemoral lymphadenectomy. Frailty screening prior to radical vulvectomy may assist in patient counseling and improve post-operative outcomes.
确定外阴癌手术后虚弱是否与术后并发症相关。
这项回顾性研究使用了来自国家外科质量改进计划（NSQIP）数据库（2014 - 2020年）的多机构数据集，以分析虚弱、手术类型与术后并发症之间的关系。使用改良虚弱指数-5（mFI-5）确定虚弱状态。进行了单变量和多变量调整的逻辑回归分析。
在886名女性中，49.9%仅接受了根治性外阴切除术，19.5%和30.6%分别同时接受了单侧或双侧腹股沟股淋巴结清扫术；24.5%的mFI≥2，被认为虚弱。与非虚弱女性相比，mFI≥2的女性更有可能出现计划外再入院（12.9%对7.8%，p = 0.02）、伤口裂开（8.3%对4.2%，p = 0.02）和深部手术部位感染（3.7%对1.4%，p = 0.04）。在多变量调整模型中，虚弱是轻微并发症（比值比[OR]1.58，95%置信区间[CI]1.09至2.30）和任何并发症（OR 1.46，95% CI 1.02至2.08）的显著预测因素。具体而言，对于双侧腹股沟股淋巴结清扫术的根治性外阴切除术，虚弱与严重并发症（OR 2.13，95% CI 1.03至4.40）和任何并发症（OR 2.10，95% CI 1.14至3.87）显著相关。
在对NSQIP数据库的这项分析中，近25%接受根治性外阴切除术的女性被认为虚弱。虚弱与术后并发症增加相关，尤其是在同时接受双侧腹股沟股淋巴结清扫术的女性中。根治性外阴切除术之前的虚弱筛查可能有助于患者咨询并改善术后结果。
