Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Minerva Anestesiol. 2024 Jan-Feb;90(1-2):59-67. doi: 10.23736/S0375-9393.23.17713-3.
Frailty, a decline in physical and cognitive reserve capacity, renders patients susceptible to various stressors and has been linked to adverse outcomes and increased healthcare utilization. This study aimed to determine whether ultrasound measurements of the rectus abdominis (RA) and biceps brachii (BB) could predict frailty in patients scheduled for total knee arthroplasty.
Frailty was assessed using the Clinical Frailty Scale in adults aged ≥60 years. Ultrasound measurements of the rectus abdominis, BB, and quadriceps femoris muscles, along with thigh circumference measurements, were obtained before surgery. The predictive ability of the unadjusted and BMI- and body surface area (BSA)-adjusted measurements were evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. Postoperative outcomes, such as admission to the intensive care unit or skilled nursing facility, delirium, falls, re-hospitalization, and 30-day mortality were recorded.
We analyzed data from 148 patients. BB thickness provided a fair prediction of frailty. Average measurements of both BB adjusted for BMI (0.708, 95% CI 0.602-0.814; P<0.001), and BSA (0.708, 95% CI 0.598-0.817; P<0.001) had the highest AUC values. RA muscle measurements could not discriminate frailty. The BMI-adjusted measurements for: right quadriceps femoris thickness (AUC 0.614, 95% CI 0.503-0.725; P=0.044), left thigh circumference (AUC 0.648, 95% CI 0.528-0.769; P=0.016), and average thigh circumference (AUC 0.630, 95% CI 0.511-0.750; P=0.033) had statistically significant but poor AUC values.
Preoperative ultrasound measurements of the bilateral BB can fairly predict frailty in patients scheduled for total knee arthroplasty.
衰弱是指身体和认知储备能力的下降，使患者易受各种压力源的影响，并与不良结局和增加的医疗保健利用相关。本研究旨在确定接受全膝关节置换术的患者的腹直肌（RA）和肱二头肌（BB）的超声测量是否可以预测衰弱。
在年龄≥60 岁的成年人中使用临床虚弱量表评估虚弱。在手术前获得 RA、BB 和股四头肌的超声测量值以及大腿周径测量值。使用接受者操作特征曲线分析和曲线下面积（AUC）值评估未调整和 BMI 和体表面积（BSA）调整后的测量值的预测能力。记录术后结局，如入住重症监护病房或熟练护理设施、谵妄、跌倒、再入院和 30 天死亡率。
我们分析了 148 名患者的数据。BB 厚度可对衰弱进行较好的预测。BB 经 BMI 调整后的平均测量值（0.708，95%CI 0.602-0.814；P<0.001）和 BSA 调整后的平均测量值（0.708，95%CI 0.598-0.817；P<0.001）具有最高的 AUC 值。RA 肌肉测量值无法区分衰弱。BMI 调整后的右侧股四头肌厚度（AUC 0.614，95%CI 0.503-0.725；P=0.044）、左侧大腿周径（AUC 0.648，95%CI 0.528-0.769；P=0.016）和平均大腿周径（AUC 0.630，95%CI 0.511-0.750；P=0.033）的 AUC 值具有统计学意义，但较差。
接受全膝关节置换术的患者双侧 BB 的术前超声测量值可以很好地预测衰弱。
