Ueno Ryo, Chan Rachel, Ling Ryan Ruiyang, Slack Ryan, Lussier Sandra, Jones Daryl, Pilcher David, Subramaniam Ashwin
Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Department of Anaesthesia and Pain Medicine, The Canberra Hospital, Canberra, Australia.
Br J Anaesth. 2025 Jun;134(6):1661-1670. doi: 10.1016/j.bja.2025.03.002. Epub 2025 Apr 23.
BACKGROUND: As the global population ages and older patients undergo surgery, understanding the association between frailty and postoperative outcomes is crucial to informed decision-making and patient care. There is a lack of research assessing the association between frailty and long-term outcomes in patients admitted to ICUs after surgery. METHODS: We conducted a multicentre retrospective cohort study using Australian and New Zealand Intensive Care Society Adult Patient Database, linked with the Australian National Death Index. Adults aged ≥16 yr admitted to the 175 ICUs in Australia between January 1, 2018, and March 31, 2022, after surgery were included. We excluded patients with cancer or admission to ICU for palliation or organ donation purpose. Patients with Clinical Frailty Scale score 5-8 were considered frail. The primary outcome was survival time up to 4 yr after ICU admission. Survival analysis was performed using mixed-effects Cox regression models and adjusted for age, sex, comorbidities, acute illness severity, and hospital types. RESULTS: We included 216 922 patients of whom 30 860 (14.2%) were frail. Patients with frailty had shorter overall survival time (median [IQR]: 16 [6-29] vs 21 [10-34] months; P<0.01) when compared with patients without frailty. After adjusting for confounders, frailty was associated with a shorter time to death (HR: 2.33, 95% CI: 2.26-2.40). This association was consistent across sensitivity analyses and subgroups. Of note, this association between frailty and shorter time to death was more pronounced in patients aged <65 yr, those undergoing elective surgery, and those without treatment limitations. CONCLUSIONS: In this multicentre study, frailty was associated with shorter time to death amongst postoperative ICU patients without cancer. The association was concordant across all subgroups.
背景:随着全球人口老龄化,老年患者接受手术的情况日益增多,了解虚弱与术后结局之间的关联对于明智的决策和患者护理至关重要。目前缺乏关于评估手术后入住重症监护病房(ICU)的患者虚弱与长期结局之间关联的研究。 方法:我们使用澳大利亚和新西兰重症监护学会成人患者数据库,并与澳大利亚国家死亡指数相链接,进行了一项多中心回顾性队列研究。纳入2018年1月1日至2022年3月31日期间在澳大利亚175个ICU接受手术后入住的年龄≥16岁的成年人。我们排除了患有癌症或因姑息治疗或器官捐献目的入住ICU的患者。临床虚弱量表评分为5 - 8分的患者被视为虚弱。主要结局是入住ICU后长达4年的生存时间。使用混合效应Cox回归模型进行生存分析,并对年龄、性别、合并症、急性疾病严重程度和医院类型进行了调整。 结果:我们纳入了216922例患者,其中30860例(14.2%)为虚弱患者。与非虚弱患者相比,虚弱患者的总生存时间较短(中位数[四分位间距]:16[6 - 29]个月对21[10 - 34]个月;P<0.01)。在对混杂因素进行调整后,虚弱与较短的死亡时间相关(风险比:2.33,9 5%置信区间:2.26 - 2.40)。这种关联在敏感性分析和亚组中是一致的。值得注意的是,虚弱与较短死亡时间之间的这种关联在年龄<65岁的患者、接受择期手术的患者以及没有治疗限制的患者中更为明显。 结论:在这项多中心研究中,虚弱与无癌症的术后ICU患者较短的死亡时间相关。这种关联在所有亚组中都是一致的。
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