接受结直肠癌手术患者的改良衰弱指数：对2015年至2019年全国住院患者样本的分析

Modified Frailty Index for Patients Undergoing Surgery for Colorectal Cancer: Analysis of the National Inpatient Sample From 2015 to 2019.

作者信息

Alsayari Rehab, McKechnie Tyler, Kazi Tania, Heimann Luke, Sachdeva Anjali, Lee Yung, Huo Bright, Sne Niv, Hong Dennis, Eskicioglu Cagla

机构信息

Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

出版信息

Am Surg. 2025 Jan;91(1):76-85. doi: 10.1177/00031348241269398. Epub 2024 Aug 6.

DOI:10.1177/00031348241269398

PMID:39663192

Abstract

BACKGROUND

Frailty is increasingly recognized as a perioperative risk for numerous surgical diseases. We applied the modified frailty index (mFI-11) to the National Inpatient Sample (NIS) for patients undergoing surgery for colorectal cancer (CRC).

METHODS

We performed a retrospective analysis of the NIS (2015-2019) including CRC patients undergoing surgery. We classified patients into frail (ie, mFI ≥0.27) and robust (ie, mFI <0.27) categories. Primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes included system-specific postoperative morbidity and length of stay (LOS). Multivariable regression models were fit.

RESULTS

Within the 53,652 identified patients undergoing surgery for CRC, 19.1% were frail. Frail patients were at higher risk of postoperative mortality (3.1% vs 1.0%, odds ratio [OR] 1.96, 95% confidence intervals [CIs] 1.68-2.30, < 0.001), morbidity (41.3 % vs 23.1%, OR 1.75, 95% CI 1.66-1.83, < 0.001), and LOS (mean difference [MD] 1.46, 95% CI 0.29-1.62, < 0.001). Significant differences existed between groups in system-specific postoperative morbidity, with the largest effect estimates seen in cardiovascular morbidities (OR 4.07, 95% CI 3.36-4.93, = 0.001), followed by respiratory (OR 1.75, 95% CI 1.66-1.83, = 0.001).

CONCLUSION

Frail patients undergoing CRC surgery are at risk of increased postoperative complications. Preoperative frailty screening may allow for individualized preoperative counseling.

摘要

背景

衰弱日益被视为多种外科疾病围手术期的风险因素。我们将改良衰弱指数（mFI-11）应用于接受结直肠癌（CRC）手术患者的全国住院患者样本（NIS）中。

方法

我们对2015年至2019年NIS中接受手术的CRC患者进行了回顾性分析。我们将患者分为衰弱组（即mFI≥0.27）和强健组（即mFI<0.27）。主要结局是术后住院期间的发病率和死亡率。次要结局包括特定系统的术后发病率和住院时间（LOS）。拟合多变量回归模型。

结果

在53652例确诊接受CRC手术的患者中，19.1%为衰弱患者。衰弱患者术后死亡风险更高（3.1%对1.0%，比值比[OR]1.96，95%置信区间[CI]1.68 - 2.30，P<0.001）、发病率更高（41.3%对23.1%，OR 1.75，95% CI 1.66 - 1.83，P<0.001）以及住院时间更长（平均差[MD]1.46，95% CI 0.29 - 1.62，P<0.001）。在特定系统的术后发病率方面，两组之间存在显著差异，最大效应估计见于心血管疾病（OR 4.07，95% CI 3.36 - 4.93，P = 0.001），其次是呼吸系统疾病（OR 1.75，95% CI 1.66 - 1.83，P = 0.001）。