Liu Zeyu, Mallick Saad, Cho Nam Yong, Aguayo Esteban, Chillakanti Mahima, Porter Giselle, Ali Konmal, Song Joseph, Tillou Areti, Benharash Peyman
Center for Advanced Surgical and Interventional Technology, Department of Surgery, University of California, Los Angeles, CA, United States of America.
Division of Trauma and Acute Care Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
Surg Open Sci. 2025 Apr 30;26:47-53. doi: 10.1016/j.sopen.2025.04.008. eCollection 2025 Jun.
With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations.
We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019-2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes.
Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0-3.0) and HF (AOR 3.3; 95 % CI, 2.7-4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2-1.4 days) and costs of $3200 (95 % CI, $3100-$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8-5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600).
Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.
随着影像学和介入技术的进步，创伤性损伤越来越多地采用非手术治疗。然而，虚弱对非手术治疗创伤性损伤预后的影响总体上仍未得到充分研究。我们利用全国性队列，描述了虚弱与非手术创伤住院患者临床及经济预后之间的关联。
我们使用2019 - 2021年全国再入院数据库，确定了所有因创伤性损伤住院的成年人（≥18岁）。仅纳入未接受大手术的患者。然后根据经过验证的医院虚弱风险评分，将患者分为三个虚弱组。随后建立多变量模型，以评估虚弱与各种临床和经济预后之间的关联。
在估计的2818070例非手术创伤住院患者中，18.6%被归类为低虚弱（LF），57.0%为中度虚弱（IF），24.4%为高虚弱（HF）。经过风险调整后，与LF相比，IF（调整优势比[AOR] 2.4；95%置信区间[CI]，2.0 - 3.0）和HF（AOR 3.3；95% CI，2.7 - 4.1）与院内死亡几率更高相关。同样，主要并发症和非回家出院的风险呈逐步上升趋势。此外，IF患者的住院时间增加了1.3天（95% CI，1.2 - 1.4天），费用增加了3200美元（95% CI，3100 - 3400美元），而HF患者的住院时间延长了5.1天（95% CI，4.8 - 5.2天），费用增加了11300美元（95% CI，11000 - 11600美元）。
我们的研究结果表明，虚弱状态与不良临床预后相关，并增加了非手术创伤住院患者的资源利用。
