Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8,, 00168, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
J Gastrointest Surg. 2023 Oct;27(10):2177-2186. doi: 10.1007/s11605-023-05820-8. Epub 2023 Sep 6.
SBO is a potentially life-threatening condition that often affects older patients. Frailty, more than age, is expected to play a crucial role in predicting SBO prognosis in this population. This study aims to define the influence of Clinical Frailty Scale (CFS) on mortality and major complications in patients ≥80 years with diagnosis of SBO at the emergency department (ED).
All patients aged ≥80 years admitted to our ED for SBO from January 2015 to September 2020 were enrolled. Frailty was assessed through the CFS, and then analyzed both as a continuous and a dichotomous variable. The endpoints were in-hospital mortality and major complications.
A total of 424 patients were enrolled. Higher mortality (20.8% vs 8.6%, p<0.001), longer hospital stay (9 [range 5-14] days vs 7 [range 4-12] days, p=0.014), and higher rate of major complications (29.9% vs 17.9%, p=0.004) were associated with CFS ≥7. CFS score and bloodstream infection were the only independent prognostic factors for mortality (OR 1.72 [CI: 1.29-2.29], p<0.001; OR 4.69 [CI: 1.74-12.6], p=0.002, respectively). Furthermore, CFS score, male sex and surgery were predictive factors for major complications (OR 1.41 [CI: 1.13-1.75], p=0.002; OR 1.67 [CI: 1.03-2.71], p=0.038); OR 1.91 [CI: 1.17-3.12], p=0.01; respectively). At multivariate analysis, for every 1-point increase in CFS score, the odds of mortality and the odds of major complications increased 1.72-fold and 1.41-fold, respectively.
The increase in CFS is directly associated with an increased risk of mortality and major complications. The presence of severe frailty could effectively predict an increased risk of in-hospital death regardless of the treatment administered. The employment of CFS in elderly patients could help the identification of the need for closer monitoring and proper goals of care.
SBO 是一种潜在危及生命的疾病，常影响老年患者。衰弱，而不是年龄，预计在该人群中对 SBO 预后有更关键的预测作用。本研究旨在定义临床虚弱量表（CFS）对急诊科（ED）诊断为 SBO 的≥80 岁患者的死亡率和主要并发症的影响。
纳入 2015 年 1 月至 2020 年 9 月期间因 SBO 入住我院 ED 的所有≥80 岁患者。通过 CFS 评估衰弱情况，并分别作为连续变量和二分变量进行分析。终点为住院死亡率和主要并发症。
共纳入 424 例患者。较高的死亡率（20.8%比 8.6%，p<0.001）、较长的住院时间（9 [范围 5-14] 天比 7 [范围 4-12] 天，p=0.014）和更高的主要并发症发生率（29.9%比 17.9%，p=0.004）与 CFS≥7 相关。CFS 评分和血流感染是死亡率的唯一独立预后因素（OR 1.72 [CI：1.29-2.29]，p<0.001；OR 4.69 [CI：1.74-12.6]，p=0.002）。此外，CFS 评分、男性和手术是主要并发症的预测因素（OR 1.41 [CI：1.13-1.75]，p=0.002；OR 1.67 [CI：1.03-2.71]，p=0.038；OR 1.91 [CI：1.17-3.12]，p=0.01）。多变量分析显示，CFS 评分每增加 1 分，死亡率和主要并发症的几率分别增加 1.72 倍和 1.41 倍。
CFS 的增加与死亡率和主要并发症的风险增加直接相关。严重衰弱的存在可有效预测住院死亡风险的增加，而与所接受的治疗无关。在老年患者中使用 CFS 有助于确定是否需要更密切的监测和适当的治疗目标。
