Stretton Brandon, Booth Andrew E C, Kovoor Joshua, Gupta Aashray, Edwards Suzanne, Hugh Tom, Maddison John, Talley Nicholas J, Plummer Mark, Meyer Emily, Horowitz Michael, Barreto Savio, Padbury Robert, Bacchi Stephen, Maddern Guy, Boyd Mark
University of Adelaide, Adelaide, South Australia, Australia.
Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
Age Ageing. 2024 Nov 28;53(12). doi: 10.1093/ageing/afae263.
Frailty, malnutrition and low socioeconomic status may mutually perpetuate each other in a self-reinforcing and interdependent manner. The intertwined nature of these factors may be overlooked when investigating impacts on perioperative outcomes. This study aimed to investigate the impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.
A multicentre cohort study involving six Australian tertiary hospitals was undertaken. All consecutive surgical patients who underwent an operation were included. Frailty was defined by the Hospital Frailty Risk Score, malnutrition by the Malnutrition Universal Screening Tool (MUST) and low socioeconomic status by the Index of Relative Socioeconomic Disadvantage. Linear mixed-effects and binary logistic generalised estimated equation models were performed for the outcomes: inpatient mortality, length of stay, 30-day readmission and re-operation.
A total of 21 976 patients were included. After controlling for confounders, malnutrition and socioeconomic status, patients at high risk of frailty have a mean hospital length of stay 3.46 times longer (mean ratio = 3.46; 95% confidence interval (CI): 3.20, 3.73; P value < .001), odds of 30-day readmission 2.4 times higher (odds ratio = 2.40; 95% CI: 2.19, 2.63; P value < .001) and odds of in-hospital mortality 12.89 times greater than patients with low risk of frailty (odds ratio = 12.89; 95% CI: 4.51, 36.69; P value < .001). Elevated MUST scores were also significantly associated with worse outcomes, but to a lesser extent. Socioeconomic status had no association with outcomes.
Perioperative risk evaluation should consider both frailty and malnutrition as separate, significant risk factors. Despite strong causal links with frailty and malnutrition, socioeconomic disadvantage is not associated with worse postoperative outcomes. Additional studies regarding the prospective identification of these patients with implementation of strategies to mitigate frailty and malnutrition and assessment of perioperative risk are required.
虚弱、营养不良和低社会经济地位可能以自我强化和相互依存的方式相互影响。在研究对围手术期结局的影响时，这些因素的交织性质可能被忽视。本研究旨在调查虚弱、营养不良和社会经济地位对围手术期结局的影响。
进行了一项涉及澳大利亚六家三级医院的多中心队列研究。纳入所有连续接受手术的患者。虚弱由医院虚弱风险评分定义，营养不良由营养不良通用筛查工具（MUST）定义，低社会经济地位由相对社会经济劣势指数定义。对以下结局进行线性混合效应和二元逻辑广义估计方程模型分析：住院死亡率、住院时间、30天再入院率和再次手术率。
共纳入21976例患者。在控制混杂因素、营养不良和社会经济地位后，虚弱高风险患者的平均住院时间长3.46倍（平均比值=3.46；95%置信区间（CI）：3.20，3.73；P值<0.001），30天再入院几率高2.4倍（比值比=2.40；95%CI：2.19，2.63；P值<0.001），院内死亡几率比虚弱低风险患者高12.89倍（比值比=12.89；95%CI：4.51，36.69；P值<0.001）。MUST评分升高也与更差的结局显著相关，但程度较小。社会经济地位与结局无关。
围手术期风险评估应将虚弱和营养不良视为单独的重要风险因素。尽管与虚弱和营养不良有很强的因果联系，但社会经济劣势与更差的术后结局无关。需要进行更多关于前瞻性识别这些患者并实施减轻虚弱和营养不良策略以及评估围手术期风险的研究。
