Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230000, China.
BMC Geriatr. 2024 Aug 13;24(1):677. doi: 10.1186/s12877-024-05281-x.
Frailty becomes more pronounced with advancing age, tightly intertwined with adverse clinical outcomes. Across diverse medical disciplines, frailty is now universally recognized as not only a risk factor but also a predictive indicator for unfavorable clinical prognosis.
This study was a retrospective cohort study that included clinical data from patients (aged ≥ 65 years) with esophageal cancer treated surgically at the First Affiliated Hospital of Anhui Medical University in 2021. For each patient, we calculated their 11-index modified frailty index(mFI-11) scores and categorized the patients into a frailty group (mFI-11hign) and a non-frailty group (mFI-11low) based on the optimal grouping cutoff value of 0.27 from a previous study. The primary study index was the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula, chylothorax, and electrolyte disturbance complications. Secondary study indicators included postoperative ICU stay, total hospitalization time, readmission rate within 30 days of discharge, and mortality within 30 days after surgery. We performed univariate and multivariate analyses to assess the association between mFI-11 and adverse outcomes as well as postoperative complications.
Five hundred and fifteen patients were included, including 64.9% (334/515) in the non-frailty group and 35.1% (181/515) in the frailty group. Comparing postoperative complication rates between the two groups revealed lower incidences of postoperative anastomotic fistula (21.5% vs. 4.5%), chylothorax (16.0% vs. 2.1%), cardiac arrhythmia (61.9% vs. 9.9%), pulmonary infections (85.1% vs. 26.6%), and electrolyte disturbance (84.5% vs. 15.0%) in patients of the non-frailty group was lower than that in the frailty group (p < 0.05). mFI-11 showed better prognostic results in predicting postoperative complications. anastomotic fistula (area under the ROC curve AUROC = 0.707), chylothorax (area under the ROC curve AUROC = 0.744), pulmonary infection (area under the ROC curve AUROC = 0.767), arrhythmia (area under the ROC curve AUROC = 0.793), electrolyte disturbance (area under the ROC curve AUROC = 0.832), and admission to ICU (area under the ROC curve AUROC = 0.700).
Preoperative frail elderly patients with esophageal cancer have a high rate of postoperative complications. mFI-11 can be used as an objective indicator for identifying elderly patients at risk for esophageal cancer.
随着年龄的增长，虚弱程度会更加明显，与不良临床结局紧密交织。在不同的医学领域，虚弱不仅被认为是一个风险因素，而且也是不良临床预后的预测指标。
本研究为回顾性队列研究，纳入 2021 年在安徽医科大学第一附属医院接受手术治疗的年龄≥65 岁食管癌患者的临床资料。对于每位患者，我们计算了其 11 项修正虚弱指数（mFI-11）评分，并根据先前研究确定的最佳分组截断值 0.27 将患者分为虚弱组（mFI-11 高）和非虚弱组（mFI-11 低）。主要研究指标为术后肺部感染、心律失常、吻合口瘘、乳糜胸和电解质紊乱并发症的发生率。次要研究指标包括术后 ICU 住院时间、总住院时间、出院后 30 天内再入院率和术后 30 天内死亡率。我们进行了单变量和多变量分析，以评估 mFI-11 与不良结局和术后并发症之间的关系。
共纳入 515 例患者，其中非虚弱组占 64.9%（334/515），虚弱组占 35.1%（181/515）。比较两组术后并发症发生率发现，非虚弱组术后吻合口瘘（21.5%比 4.5%）、乳糜胸（16.0%比 2.1%）、心律失常（61.9%比 9.9%）、肺部感染（85.1%比 26.6%）和电解质紊乱（84.5%比 15.0%）的发生率较低（p<0.05）。mFI-11 对预测术后并发症具有更好的预后价值。吻合口瘘（ROC 曲线下面积 AUROC=0.707）、乳糜胸（ROC 曲线下面积 AUROC=0.744）、肺部感染（ROC 曲线下面积 AUROC=0.767）、心律失常（ROC 曲线下面积 AUROC=0.793）、电解质紊乱（ROC 曲线下面积 AUROC=0.832）和 ICU 入住（ROC 曲线下面积 AUROC=0.700）。
术前虚弱的老年食管癌患者术后并发症发生率较高。mFI-11 可作为识别食管癌高危老年患者的客观指标。
