Cunningham Michaela R, Cramer Christopher L, Jin Ruyun, Turrentine Florence E, Zaydfudim Victor M
Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, USA.
Patient Saf Surg. 2025 Jan 9;19(1):1. doi: 10.1186/s13037-024-00424-w.
While existing risk calculators focus on mortality and complications, elderly patients are concerned with how operations will affect their quality of life, especially their independence. We sought to develop a novel clinically relevant and easy-to-use score to predict elderly patients' loss of independence after gastrointestinal surgery.
This retrospective cohort study included patients age ≥ 65 years enrolled in the American College of Surgeons National Surgical Quality Improvement Program database and Geriatric Pilot Project who underwent pancreatic, colorectal, or hepatic surgery (January 1, 2014- December 31, 2018). Primary outcome was loss of independence - discharge to facility other than home and decline in functional status. Patients from 2014 to 2017 comprised the training data set. A logistic regression (LR) model was generated using variables with p < 0.2 from the univariable analysis. The six factors most predictive of the outcome composed the short LR model and scoring system. The scoring system was validated with data from 2018.
Of 6,510 operations, 841 patients (13%) lost independence. Training and validation datasets had 5,232 (80%) and 1,278 (20%) patients, respectively. The six most impactful factors in predicting loss of independence were age, preoperative mobility aid use, American Society of Anesthesiologists classification, preoperative albumin, non-elective surgery, and race (all OR > 1.83; p < 0.001). The odds ratio of each of these factors were used to create a sixteen-point scoring system. The scoring system demonstrated satisfactory discrimination and calibration across the training and validation datasets, with Receiver Operating Characteristic Area Under the Curve 0.78 in both and Hosmer-Lemeshow statistic of 0.16 and 0.34, respectively.
This novel scoring system predicts loss of independence for geriatric patients after gastrointestinal operations. Using readily available variables, this tool can be applied in the urgent setting and can contribute to elderly patients and their family discussions related to loss of independence prior to high-risk gastrointestinal operations. The applicability of this scoring tool to additional surgical sub-specialties and external validation should be explored in future studies.
虽然现有的风险计算器侧重于死亡率和并发症，但老年患者关注手术将如何影响他们的生活质量，尤其是他们的独立性。我们试图开发一种新的、具有临床相关性且易于使用的评分系统，以预测老年患者胃肠手术后独立性的丧失。
这项回顾性队列研究纳入了年龄≥65岁、参加美国外科医师学会国家外科质量改进计划数据库和老年试点项目且接受胰腺、结肠或肝脏手术的患者（2014年1月1日至2018年12月31日）。主要结局是独立性丧失——出院至非家中机构以及功能状态下降。2014年至2017年的患者组成训练数据集。使用单变量分析中p<0.2的变量生成逻辑回归（LR）模型。对结局预测性最强的六个因素构成了简短的LR模型和评分系统。该评分系统用2018年的数据进行了验证。
在6510例手术中，841例患者（13%）丧失了独立性。训练数据集和验证数据集分别有5232例（80%）和1278例（20%）患者。预测独立性丧失的六个最具影响力的因素是年龄、术前使用行动辅助器具情况、美国麻醉医师协会分级、术前白蛋白水平、非择期手术和种族（所有比值比>1.83；p<0.001）。这些因素各自的比值比被用于创建一个16分的评分系统。该评分系统在训练数据集和验证数据集中均显示出令人满意的区分度和校准度，两个数据集的受试者工作特征曲线下面积均为0.78，Hosmer-Lemeshow统计量分别为0.16和0.34。
这种新的评分系统可预测老年患者胃肠手术后独立性的丧失。利用易于获得的变量，该工具可在紧急情况下应用，并有助于老年患者及其家属在高风险胃肠手术前就独立性丧失问题进行讨论。未来的研究应探索该评分工具在其他外科亚专业中的适用性以及外部验证情况。
