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| 全麻下非心脏手术老年患者术前衰弱评估对术后3个月内预后的预测价值 |
| Predictive value of preoperative frailty assessment on prognosis within 3 months after surgery in elderly patients undergoing non-cardiac surgery with general anesthesia |
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| DOI：10.12089/jca.2021.10.009 |
| 中文关键词: 衰弱 非心脏手术 评估方法 预后 |
| 英文关键词: Frailty Non-cardiac surgery Assessment method Outcome |
| 基金项目:江苏省第五期“333工程”（BRA2018396）；江苏省第十五批“六大人才高峰”高层次人才（WSW-041） |
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| 中文摘要: |
目的 比较3种术前衰弱评估方法对全麻下行非心脏手术老年患者术后3个月内预后的预测效能。
方法 选择2019年2—6月在全麻下行择期非心脏手术的老年患者311例，男178例，女133例，年龄≥65岁，ASA Ⅱ或Ⅲ级。术前采用表型评估法（Fried）、修正后衰弱指数（mFI）和衰弱基本工具法（EFT）评估术前衰弱状态。记录手术时间、术中出血量、术后ICU入住情况、住院时间、手术至出院时间、术后3个月内再入院及死亡例数。采用单因素分析和多因素Logistic回归分析患者术前衰弱与预后的相关性。采用受试者工作特征（ROC）曲线分析3种评估方法的预测效能。
结果 Fried、mFI与EFT评估患者术前衰弱的发生率分别为33.4%、19.6%和21.5%。单因素分析显示，3种方法评估衰弱患者术后ICU入住率均明显高于非衰弱患者（P＜0.05）；Fried和EFT评估衰弱患者术后3个月内死亡率明显高于非衰弱患者（P＜0.05）；mFI评估衰弱患者术后3个月内再入院率明显高于非衰弱患者（P＜0.05）。多因素Logistic回归分析显示，Fried（RR=9.816，95%CI 2.660~36.227，P<0.001）、mFI（RR=4.834，95%CI 1.844~12.672，P<0.001）、EFT（RR=5.317，95% CI 2.002~14.124，P<0.001）评估虚弱患者术后进入ICU的风险均明显升高。ROC曲线分析显示，Fried、mFI和EFT预测术后入ICU的曲线下面积（AUC）分别为0.859、0.836及0.849，临界值分别为0.10、0.11及0.06，敏感性分别为84.0%、76.0%及76.0%，特异性分别为80.8%、87.4%及78.0%（P<0.05）。
结论 在预测患者术后3个月内预后时，需根据不同预后选择合适的术前衰弱评估方法。术前衰弱是术后入ICU的独立风险因素，且3种评估方法中Fried评估法更具有临床预测价值。 |
| 英文摘要: |
Objective To compare the predictive value of three preoperative frailty assessment methods in predicting the prognosis within 3 months after surgery in elderly patients undergoing non-cardiac surgery with general anesthesia.
Methods A total of 311 elderly patients undergoing non-cardiac surgery under general anesthesia, 178 males and 133 females, aged ≥ 65 years, ASA physical status Ⅱ or Ⅲ, were recruited. Three assessment methods were used to evaluate the frailty state before the operation. The operative time and intraoperative blood loss of the patients were recorded during the operation. ICU admission, length of stay (LOS), time from operation to discharge, readmission rate and mortality within 3 months after the operation were recorded. Univariate analysis and multivariate logistic regression were used to analyze the correlation between frailty state and prognosis. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the three assessment methods.
Results Frailty prevalence of Fried, mFI, and EFT was 33.4%, 19.6%, and 21.5%, respectively. Univariate analysis showed that the postoperative ICU occupancy rate of patients with frailty was higher than that of patients without frailty, no matter which frailty assessment method was used. Only when Fried and EFT were used, the mortality of frail patients within 3 months after surgery was higher than that of non-frail patients (P < 0.05). Only when mFI was used, the rate of readmission within 3 months after surgery was higher in frail patients than in non-frail patients (P < 0.05). Logistic regression analysis showed that frail patients had higher risk of postoperative ICU admission than non-frail patients, no matter Fried (RR = 9.816, 95% CI 2.660-36.227, P < 0.001), mFI (RR = 4.834, 95% CI 1.844-12.672, P < 0.001) or EFT (RR = 5.317, 95% CI 2.002-14.124, P < 0.001) was used. ROC curve analysis showed that the area under the curve (AUC) of Fried, mFI, and EFT for predicting postoperative ICU admission was 0.859, 0.836, and 0.849, with critical value of 0.10, 0.11, and 0.06, sensitivity of 84.0%, 76.0%, and 76.0%, and specificity of 80.8%, 87.4%, and 78.0%, respectively (P < 0.05).
Conclusion In predicting the prognosis of patients within 3 months after surgery, appropriate methods of frailty assessment should be selected according to different prognosis. Preoperative frailty is an independent risk factor for ICU admission after surgery, and among the three assessment methods, Fried assessment is more valuable for clinical prediction. |
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