Weinberg Laurence, Lee Dong Kyu, Fletcher Luke, Ou Yang Bobby, Karp Jadon, Koshy Anoop N, Guha Ranjan, Slifirski Hugh, D'Silva Michael R, Bellomo Rinaldo, Churilov Leonid
From the Department of Anesthesia, Austin Health, Heidelberg, Australia.
Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia.
Ann Surg Open. 2024 Nov 18;5(4):e524. doi: 10.1097/AS9.0000000000000524. eCollection 2024 Dec.
To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission.
There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients-people aged 90 to 99 years and >100 years.
In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled. Surgery severity was stratified, and the incidence and grade of postoperative complications were recorded. Multivariable logistic regression analysis was performed on a training cohort, followed by calibration on a validation cohort, followed by performance evaluation on a testing cohort. The discriminative accuracy was compared to that of the age-adjusted Charlson Comorbidity Index for each outcome. The primary outcome was the ability of the risk stratification tool to effectively classify patients into those who may or may not experience a postoperative complications or mortality within their index hospital stay.
A total of 3085 patients were enrolled. The GERIATRIC risk tool had good discriminative accuracy for any postoperative complication [area under the receiver operating characteristic curves (AUROC), 0.857; 95% CI = 0.824-0.890] and any severe postoperative complication (AUROC, 0.833; 95% CI = 0.793-0.874), and fair discriminative accuracy for in-hospital mortality (AUROC, 0.780; 95% CI = 0.668-0.893).
Compared to the age-adjusted Charlson Comorbidity Index, The GERIATRIC risk tool was accurate in classifying patients into those who may or may not experience severe complications or die during their index admission. The tool can be used to assist perioperative clinicians with shared decision-making and short-term prognostication.
开发适合年龄的老年（90至99岁及100岁以上）手术风险工具，用于对在其首次住院期间可能发生或不发生术后并发症或死亡的患者进行分类。
目前尚无经过验证的围手术期风险分层工具可用于90至99岁及100岁以上的老年患者。
在这项回顾性观察研究中，对接受任何手术的90至99岁及100岁以上患者进行了分析。对手术严重程度进行分层，并记录术后并发症的发生率和等级。对一个训练队列进行多变量逻辑回归分析，随后在一个验证队列上进行校准，然后在一个测试队列上进行性能评估。将每个结果的判别准确性与年龄调整后的查尔森合并症指数进行比较。主要结果是风险分层工具能否有效地将患者分类为在其首次住院期间可能发生或不发生术后并发症或死亡的患者。
共纳入3085例患者。老年手术风险工具对任何术后并发症[受试者操作特征曲线下面积（AUROC），0.857；95%可信区间 = 0.824 - 0.890]和任何严重术后并发症（AUROC，0.833；95%可信区间 = 0.793 - 0.874）具有良好的判别准确性，对院内死亡率具有中等判别准确性（AUROC，0.780；95%可信区间 = 0.668 - 0.893）。
与年龄调整后的查尔森合并症指数相比，老年手术风险工具在将患者分类为在其首次住院期间可能发生或不发生严重并发症或死亡的患者方面是准确的。该工具可用于协助围手术期临床医生进行共同决策和短期预后评估。
