Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Surg Res. 2024 May;297:71-82. doi: 10.1016/j.jss.2023.12.008. Epub 2024 Mar 5.
Studies identifying predictors of postoperative outcomes in adhesive small bowel obstruction are limited. This study investigates the efficacy of the modified frailty index (mFI)to predict postoperative morbidity and mortality among patients undergoing surgery for adhesive small bowel obstruction.
A multicentre retrospective cohort study including patients undergoing surgery for adhesive small bowel obstruction after failed trial of nonoperative management between January 2015 and December 2020 was performed. Impact of frailty status using the mFI, stratified as frail (≥0.27) and robust (<0.27), on postoperative morbidity, mortality, length of stay, and discharge destination was evaluated using multiple logistic regression.
Ninety-two robust patients (mean age 62.4 y, 68% female) and 41 frail patients (mean age 81.7 y, 63% female) were included. On simple stratification, frail patients had significantly increased 30-d morbidity (overall morbidity 80% versus 49%) and need for higher level of care on discharge (41% versus 9%). However, on multiple regression, functional dependence but not the mFI, was independently associated with worse 30-d overall morbidity (odds ratio [OR] 3.97, confidence interval [CI] 1.29-12.19) and lower likelihood of returning to preoperative disposition (OR 0.21, CI 0.05-0.91). The delay in operation beyond 5 d was independently associated with worse 30-d outcomes including overall morbidity and mortality (OR 7.54, CI 2.13-26.73) and decreased return to preoperative disposition (OR 0.14, CI 0.04-0.56).
The mFI, although promising, was not independently predictive of outcomes following surgery for adhesive small bowel obstruction. Further adequately powered studies are required.
目前针对粘连性小肠梗阻术后结局预测因素的研究有限。本研究旨在探讨改良衰弱指数（mFI）预测粘连性小肠梗阻患者手术后发病率和死亡率的效果。
本研究为多中心回顾性队列研究，纳入了 2015 年 1 月至 2020 年 12 月期间接受粘连性小肠梗阻手术后非手术治疗失败的患者。使用 mFI 评估衰弱状态的影响，分层为脆弱（≥0.27）和稳健（<0.27），并使用多因素逻辑回归评估其对术后发病率、死亡率、住院时间和出院去向的影响。
共纳入 92 例稳健患者（平均年龄 62.4 岁，68%为女性）和 41 例脆弱患者（平均年龄 81.7 岁，63%为女性）。简单分层后，脆弱患者的 30 天发病率显著升高（总发病率 80%对 49%），出院时需要更高水平的护理（41%对 9%）。然而，多因素回归分析显示，功能依赖而非 mFI 与 30 天总发病率更高（比值比[OR]3.97，95%置信区间[CI]1.29-12.19）和术前状态恢复可能性降低独立相关（OR 0.21，95%CI 0.05-0.91）。手术延迟超过 5 天与 30 天结局较差（包括总发病率和死亡率）以及术前状态恢复可能性降低（OR 7.54，95%CI 2.13-26.73）和降低术前状态恢复可能性（OR 0.14，95%CI 0.04-0.56）独立相关。
mFI 虽然有前景，但不能独立预测粘连性小肠梗阻手术后的结局。需要进一步进行足够大的、有力的研究。
