Huggins Ashley, Casson Cameron, Holden Tim, Majumder Arnab, Blatnik Jeffrey, Holden Sara E
Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
Division of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis, Saint Louis, USA.
Surg Endosc. 2024 Dec;38(12):7569-7576. doi: 10.1007/s00464-024-11250-7. Epub 2024 Sep 18.
Frailty is increasingly recognized as a preoperative predictor of adverse outcomes following various surgical procedures. Our study aims to compare validated frailty measures in the ventral hernia population, as this is a common elective procedure with a paucity of data regarding frailty prevalence.
Patients aged 18 years or older with planned ventral hernia repairs were prospectively enrolled in our single-institution study from January 2023 through June 2023. After obtaining informed consent, patients completed the Fried Frailty Index (FFI), the FRAIL Scale, and the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaires, as well as the standard completion of the Patient-Reported Outcomes Measurement Information System (PROMIS) measures at their preoperative clinic appointment. Chart review was performed for baseline demographics and comorbidities. The Modified Frailty Index (mFI-11) and the Charleston Comorbidity Index (CCI) were calculated.
A total of 63 patients were enrolled in our study. On average, the population was 60 years old, with a BMI of 32.4 kg/m, a CCI of 3, and on 10.5 medications preoperatively. Overall, 12 patients (19%) screened positive for frailty by the mFI-11, 17 patients (27%) by the FFI, 15 patients (23.8%) by the FRAIL Scale, and 15 patients (23.8%) screened positive for sarcopenia by SARC-F. The FFI and the FRAIL Scale were strongly correlated with the other measures by Spearman's rank-order correlation (p < 0.05). On multivariate regression analysis, a longer Timed Up and Go test was associated with screening positive for frailty or sarcopenia (OR 1.896, p = 0.016).
In this study, we find that frailty is more prevalent than previously reported in the literature by any measure used. Both the FRAIL Scale and FFI strongly correlate with the other tools investigated. Surgeons should consider using these assessments preoperatively to estimate frailty and guide operative planning as well as shared decision-making.
衰弱越来越被认为是各种外科手术后不良结局的术前预测指标。我们的研究旨在比较腹疝患者中经过验证的衰弱测量方法，因为这是一种常见的择期手术，关于衰弱患病率的数据较少。
2023年1月至2023年6月，年龄在18岁及以上、计划进行腹疝修补术的患者前瞻性纳入我们的单机构研究。在获得知情同意后，患者完成了弗里德衰弱指数（FFI）、衰弱量表、力量、辅助行走、从椅子上起身、爬楼梯和跌倒（SARC - F）问卷，以及在术前门诊预约时完成患者报告结局测量信息系统（PROMIS）的标准测量。对基线人口统计学和合并症进行病历审查。计算改良衰弱指数（mFI - 11）和查尔斯顿合并症指数（CCI）。
我们的研究共纳入63例患者。平均而言，该人群年龄为60岁，体重指数为32.4kg/m，CCI为3，术前服用10.5种药物。总体而言，12例患者（19%）经mFI - 11筛查衰弱呈阳性，17例患者（27%）经FFI筛查呈阳性，15例患者（23.8%）经衰弱量表筛查呈阳性，15例患者（23.8%）经SARC - F筛查肌肉减少症呈阳性。通过Spearman等级相关分析，FFI和衰弱量表与其他测量方法高度相关（p < 0.05）。多因素回归分析显示，计时起立行走测试时间较长与衰弱或肌肉减少症筛查呈阳性相关（OR 1.896，p = 0.016）。
在本研究中，我们发现无论采用何种测量方法，衰弱的患病率均高于以往文献报道。衰弱量表和FFI与其他所研究工具均高度相关。外科医生应考虑在术前使用这些评估方法来评估衰弱情况，指导手术规划以及共同决策。
