Kent Johnathan R, Chavez Julia, Rubin Daniel, Gleason Lauren J, Landi Andrea, Huisingh-Scheetz Megan, Bryan Darren S, Ferguson Mark K, Donington Jessica, Madariaga Maria Lucia
Department of Surgery, University of Chicago, Chicago, Illinois.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois.
Ann Thorac Surg Short Rep. 2024 Jan 20;2(3):581-585. doi: 10.1016/j.atssr.2023.12.012. eCollection 2024 Sep.
Frailty is associated with increased perioperative morbidity and mortality. How thoracic surgeons recognize, measure, and mitigate frailty in their daily clinical practice is unknown. We administered a national survey to determine the current practices of thoracic surgeons managing frail patients.
A 144-question survey developed in collaboration with the University of Chicago Survey Lab was sent to CTSnet.org members who identified as general thoracic surgeons, practiced in the United States, and had publicly available emails. Responses were collected from August 12 to September 11, 2022. Both fully and partially (at least 20%) completed surveys were included in a descriptive statistical analysis.
After 2796 surveys were administered, 342 surgeons responded. Surgeons were in practice a median of 23 years (range, 1-50 years) at academic (63.4% [187/295]) or community (36.6% [108/295]) centers. Most surgeons believed it important to assess frailty preoperatively (83.9% [287/342]), but only 28% (97/342) of surgeons performed routine frailty assessment. Barriers to routine frailty assessment included lack of tools (80.0% [32/40]), training (59.0% [23/39]), and staffing (56.4% [22/39]). Whereas most surgeons believed that frailty could be mitigated (72.2% [247/342]), only 49.5% (156/315) prescribed prehabilitation. Up to 78.7% (203/263) of surgeons would delay or cancel surgery for patient frailty, depending on disease cause.
Thoracic surgeons recognize that frailty is an established risk factor for perioperative morbidity and mortality; however, there is high variability in diagnosis and management of frailty. Guidelines are needed to establish best practices for screening and mitigation to optimally treat frail patients.
衰弱与围手术期发病率和死亡率增加相关。胸外科医生在日常临床实践中如何识别、测量和减轻衰弱尚不清楚。我们进行了一项全国性调查，以确定胸外科医生管理衰弱患者的当前做法。
与芝加哥大学调查实验室合作开发的一项包含144个问题的调查问卷被发送给CTSnet.org的成员，这些成员被认定为普通胸外科医生，在美国执业，且有公开可用的电子邮件。于2022年8月12日至9月11日收集回复。完整和部分（至少20%）完成的调查问卷都纳入描述性统计分析。
在发放2796份调查问卷后，有342名外科医生做出回复。外科医生在学术（63.4%[187/295]）或社区（36.6%[108/295]）中心的执业年限中位数为23年（范围为1 - 50年）。大多数外科医生认为术前评估衰弱很重要（83.9%[287/342]），但只有28%（97/342）的外科医生进行常规衰弱评估。常规衰弱评估的障碍包括缺乏工具（80.0%[32/40]）、培训（59.0%[23/39]）和人员配备（56.4%[22/39]）。虽然大多数外科医生认为衰弱可以减轻（72.2%[247/342]），但只有49.5%（156/315）的医生开了术前康复的处方。高达78.7%（203/263）的外科医生会根据疾病原因，因患者衰弱而推迟或取消手术。
胸外科医生认识到衰弱是围手术期发病率和死亡率的既定危险因素；然而，在衰弱的诊断和管理方面存在很大差异。需要制定指南来确立筛查和减轻衰弱的最佳实践，以优化对衰弱患者的治疗。
