Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM, USA.
Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
Int J Obes (Lond). 2024 Mar;48(3):360-369. doi: 10.1038/s41366-023-01423-0. Epub 2023 Dec 18.
BACKGROUND/OBJECTIVES: Obesity is a global health challenge that affects a large proportion of adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another's negative effects. Therefore, we sought to compare the discriminatory thresholds of the risk analysis index (RAI), 5-factor modified frailty index (m-FI-5) and patient age for the primary endpoint of postoperative mortality.
SUBJECTS/METHODS: We included spine surgery patients ≥18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classified as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for postoperative mortality. Proportional hazards risk-adjusted regressions were performed, and Hazard ratios and corresponding 95% Confidence intervals (CI) are reported.
Overall, there were 149 163 patients evaluated, and in the ROC analysis for postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95%CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95%CI 0.650-0.691), and patient age C-statistic 0.686 (95%CI 0.666-0.707). Risk-adjusted analyses were performed, and the RAI had a stepwise increasing effect size across frailty strata: typical patients HR 2.55 (95%CI 2.03-3.19), frail patients HR 3.48 (95%CI 2.49-4.86), and very frail patients HR 4.90 (95%CI 2.87-8.37). We found increasing postoperative mortality effect sizes within Clavein-Dindo complication strata, consistent across obesity categories, exponentially increasing with frailty, and multiplicatively enhanced within CD, frailty and obesity strata.
In this study of 149 163 patients classified as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.
背景/目的：肥胖是一个全球性的健康挑战，影响着全球很大一部分成年人。肥胖和虚弱会带来相当大的健康风险，因为它们有可能相互作用，并放大彼此的负面影响。因此，我们试图比较风险分析指数（RAI）、5 因素改良虚弱指数（mFI-5）和患者年龄对术后死亡率这一主要终点的判别阈值。
受试者/方法：我们纳入了 2012 年至 2020 年期间美国外科医师学院国家质量改进计划数据库中年龄≥18 岁的肥胖脊柱手术患者。我们进行了受试者工作特征曲线分析，比较 RAI、mFI-5 和患者年龄对术后死亡率的判别阈值。进行了比例风险调整回归，报告了危险比和相应的 95%置信区间（CI）。
总共评估了 149163 例患者，在术后死亡率的 ROC 分析中，RAI 的判别 C 统计量为 0.793（95%CI：0.773-0.813），优于 mFI-5 的 C 统计量 0.671（95%CI 0.650-0.691）和患者年龄的 C 统计量 0.686（95%CI 0.666-0.707）。进行了风险调整分析，RAI 在虚弱分层中表现出逐步增加的效应大小：典型患者 HR 2.55（95%CI 2.03-3.19），虚弱患者 HR 3.48（95%CI 2.49-4.86），非常虚弱患者 HR 4.90（95%CI 2.87-8.37）。我们发现，随着虚弱程度的增加，Clavein-Dindo 并发症分层中的术后死亡率效应大小不断增加，在肥胖类别中一致，呈指数增加，并与 CD、虚弱和肥胖分层呈乘法增强。
在这项对 149163 例肥胖患者进行的研究中，这些患者在国际前瞻性外科数据库中接受脊柱手术，RAI 在预测术后死亡率风险方面的判别能力优于 mFI-5 和患者年龄。虚弱和肥胖的有害影响具有协同作用，因为它们的综合作用预测了更差的结果。
