可能患有肌肉减少症和营养不良的大型肿瘤手术患者的 30 天再入院率。

The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery.

机构信息

Health Sciences by the Graduate Program in Health Sciences, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil.

Postgraduate Program in Health Sciences, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil.

出版信息

Einstein (Sao Paulo). 2024 Oct 14;22:eAO0733. doi: 10.31744/einstein_journal/2024AO0733. eCollection 2024.

DOI:10.31744/einstein_journal/2024AO0733

PMID:39417481

Abstract

BACKGROUND

Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.0%. In multivariate analysis, the overlap of probable sarcopenia and malnutrition was a significant predictor for the 30-day unplanned readmission (OR= 8.10, 95%CI= 1.20-0.55; p=0.032).

BACKGROUND

■ Probable sarcopenia plus malnutrition was significantly associated with unplanned readmission.

BACKGROUND

■ Overlap of probable sarcopenia and malnutrition was an independent risk factor for readmission.

BACKGROUND

■ Certification of whether the patient is malnourished and/or sarcopenic preoperatively is necessary.

BACKGROUND

■ SARC-F and subjective global assessment can effectively and easily assess sarcopenia and malnutrition at admission.

OBJECTIVE

To assess the 30-day unplanned readmission rate and its association with overlapping probable sarcopenia and malnutrition after major oncological surgery.

METHODS

A prospective bicentric observational cohort study performed with adult oncological patients undergoing major surgery. The primary outcome was unplanned readmission within 30 days after discharge and the association with probable sarcopenia and malnutrition. Nutritional status and probable sarcopenia were assessed just prior to surgery. Patients classified using subjective global assessment, as B and C were malnourished. Probable sarcopenia was defined using SARC-F (strength, assistance with walking, rise from a chair, climb stairs, falls) questionnaire ≥4 points and low HGS (handgrip strength) <27kg for males and <16kg for females.

RESULTS

Two hundred and thirty-eight patients (51.7% female) with a median age of 60 years were included. The 30-day readmission rate was 9.0% (n=20). Univariate analysis showed an association of malnutrition (odds ratio (OR) = 4.84; p=0.024) and probable sarcopenia (OR = 4.94; p=0.049) with 30-day readmission. Furthermore, when both conditions were present, the patient was almost nine times more likely to be readmitted (OR = 8.9; p=0.017). Multivariable logistic regression analysis showed that overlapping probable sarcopenia and malnutrition was an independent predictor of 30-day unplanned readmission (OR = 8.10, 95% confidence interval (95%CI) 1.20-0.55; p=0.032).

CONCLUSION

The 30-day unplanned readmission rate was 9.0%, and the overlap of probable sarcopenia and malnutrition is an independent predictor for the 30-day unplanned readmission after major oncologic surgery.

摘要

背景

在肿瘤外科中，重叠的肌肉减少症和营养不良可能会增加再入院的风险。在 238 名患者中发现重叠的疑似肌肉减少症/营养不良发生率为 4.6%，30 天非计划性再入院率为 9.0%。多变量分析显示，疑似肌肉减少症和营养不良的重叠是 30 天非计划性再入院的显著预测因素（OR=8.10，95%CI=1.20-0.55；p=0.032）。

背景

疑似肌肉减少症加营养不良与非计划性再入院显著相关。

背景

疑似肌肉减少症和营养不良的重叠是再入院的独立危险因素。

背景

术前需要确认患者是否营养不良和/或存在肌肉减少症。

背景

SARC-F 和主观全面评估可在入院时有效且轻松地评估肌肉减少症和营养不良。

目的

评估主要肿瘤手术后 30 天内非计划性再入院率及其与重叠疑似肌肉减少症和营养不良的关系。

方法

对接受大手术的成年肿瘤患者进行前瞻性双中心观察队列研究。主要结局为出院后 30 天内非计划性再入院，以及与疑似肌肉减少症和营养不良的关系。在手术前评估营养状况和疑似肌肉减少症。使用主观全面评估，B 和 C 级患者被认为是营养不良的。疑似肌肉减少症通过 SARC-F（力量、行走辅助、从椅子上站起来、爬楼梯、跌倒）问卷≥4 分和男性低握力（<27kg）和女性低握力（<16kg）来定义。

结果

共纳入 238 名（51.7%为女性）中位年龄为 60 岁的患者。30 天再入院率为 9.0%（n=20）。单因素分析显示，营养不良（比值比（OR）=4.84；p=0.024）和疑似肌肉减少症（OR=4.94；p=0.049）与 30 天再入院相关。此外，当两种情况同时存在时，患者再入院的可能性几乎增加了九倍（OR=8.9；p=0.017）。多变量逻辑回归分析显示，重叠的疑似肌肉减少症和营养不良是 30 天非计划性再入院的独立预测因素（OR=8.10，95%置信区间（95%CI）为 1.20-0.55；p=0.032）。