Xu Jane Y, Madden Hannah E, Martínez-Camblor Pablo, Deiner Stacie G
Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
University of New England College of Osteopathic Medicine, Biddeford, ME, United States of America.
J Clin Anesth. 2025 Feb;101:111730. doi: 10.1016/j.jclinane.2024.111730. Epub 2024 Dec 20.
Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.
We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 < 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type.
Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36-3.64) and 4.64 days (95 % CI 3.96-5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79-3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48-0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47-0.59).
Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.
衰弱是一种对生理应激恢复力下降的综合征，与特定手术术后住院时间（LOS）延长有关。然而，文献中缺乏对衰弱与各类外科手术住院时间之间关系的大规模分析。
我们使用美国外科医师学会国家外科质量改进计划（ACS NSQIP®）数据，对2015年至2019年间接受住院手术（包括急诊手术）的65岁及以上患者进行了一项回顾性队列研究。通过改良的5项衰弱指数（mFI-5）测量的衰弱被分类为非衰弱（mFI-5 < 2）或衰弱（mFI-5≥2）。我们对住院时间进行建模，调整了人口统计学变量、合并症和手术因素，并根据急诊手术状态和手术类型进行了亚组分析。
在1,254,809名患者中，29.0%为衰弱患者。衰弱患者中黑人（10%对5.5%）、西班牙裔（6.1%对3.8%）、美国麻醉医师协会（ASA）IV/V级（23.3%对9.1%）、营养不良（2.7%对1.9%）的比例更高，并且接受血管手术的比例也更高（16.5%对8.3%）。除减重手术外，他们在所有手术中的中位住院时间都更长。未调整分析显示，与mFI-5评分为0相比，mFI-5评分为4和5分别使中位住院时间增加3.5天（95%CI 3.36 - 3.64）和4.64天（95%CI 3.96 - 5.32）。在调整分析中，衰弱仍然是中位住院时间增加的显著危险因素，与mFI-5评分为0相比，mFI-5评分为5与延长3天的住院时间相关（95%CI 2.79 - 3.22）。亚组分析表明，mFI-5评分每增加1分，在急诊手术（0.5天，95%CI 0.48 - 0.52）和下肢搭桥手术（0.53天，95%CI 0.47 - 0.59）中与中位住院时间增加的关联最强。
即使在调整患者和手术协变量后，衰弱仍是老年手术患者术后住院时间延长的独立危险因素。住院时间增加的其他独立危险因素包括急诊手术、营养不良和更高的ASA分级。
