老年衰弱与腹部外科术后短期预后的相关性研究

Study on the correlation between frailty of elderly patients and short-term prognosis after abdominal surgery

目的研究老年患者术前衰弱与腹部外科术后短期预后的相关性,并探讨其预测价值。方法前瞻性观察天津市第三中心医院2017年7-12月进行腹部外科手术的老年患者156例,术前依据Fried衰弱表型评分分为无衰弱组、衰弱前期组及衰弱组。比较3组的术后住院时间及不良结局发生率,并分析衰弱对美国麻醉学会(ASA)风险预测模型的作用。结果3组老年患者术后住院时间分别为(6.50 ± 4.08)、(9.45 ± 8.10)、(12.14 ± 7.05)d,差异有统计学意义(F=7.46,P<0.01)。3组老年患者术后不良结局发生率比较,差异有统计学意义(χ^2=23.30,P<0. 01)。负二项回归分析发现,术前衰弱与术后住院时间延长有关,衰弱前期发生率比率IRR=1.428(95%CI 1.250~1.974),衰弱发生率比率IRR=3.692(95%CI 1.282~4.230)。Logistic回归分析发现,术前衰弱与术后不良结局风险增加有关,衰弱前期OR=2.303(95%CI 1.810~4.127),衰弱OR=3.512(95%CI 2.054~5.689)。衰弱增加了ASA风险预测模型的诊断价值(Z=3.718,P<0. 01)。结论老年衰弱是腹部外科手术短期预后的重要预测因子,并增加了ASA风险模型的诊断价值,术前对腹部外科手术老年患者进行衰弱评估有助于术前临床决策及预后评估。

Objective To study the correlation between preoperative frailty and short-term prognosis after abdominal surgery, and to explore its predictive value.Methods A total of 156 elderly patients undergoing abdominal surgery from July 2017 to December 2017 in Tianjin Third Center Hospital were prospectively observed and classified into non-frail group, pre-frail group and frail group according to the Fried's frailty phenotype before surgery. The postoperative hospital stay and incidence of adverse outcomes were compared among the three groups, and the effect of frailty on the risk prediction model of the American Society of Anesthesiology (ASA) was analyzed.Results The postoperative hospital stay and the incidence of adverse outcomes in the three groups were statistically significant (P<0.05). Negative binomial regression analysis found that preoperative frailty was associated with prolonged postoperative hospital stay (pre-frail incidence rate ratio was 1.428 (95% CI: 1.250-1.974);frail incidence rate ratio was 3.692 (95% CI: 1.282-4.230). Logistic regression analysis found that preoperative frailty was associated with an increased risk of postoperative adverse outcomes (pre-frail: OR= 2.303(95% CI: 1.810-4.127); frail: OR=3.512 (95% CI: 2.054-5.689)). Frailty increased the diagnostic value of the ASA risk prediction model (Z=3.718, P<0.01).Conclusions Frailty of elderly patients is an important predictor of short-term prognosis of abdominal surgery, and it increases the diagnostic value of ASA risk model. The preoperative frailty assessment of elderly patients undergoing abdominal surgery is helpful for preoperative clinical decision-making and prognosis evaluation.