改良衰弱指数预测老年全髋关节置换术后并发症的临床应用

Clinical application of modified frailty index in predicting complications after total hip arthroplasty in the elderly

目的 探讨改良衰弱指数(mFI-5)预测老年全髋关节置换术后并发症的临床应用价值,为患者围手术期综合干预提供参考依据。方法 回顾性分析2014年1月至2019年8月于中国人民解放军总医院第一医学中心骨科收治的年龄≥65岁的老年全髋关节置换手术639例患者的临床资料。收集患者人口统计学资料、手术相关信息、mFI-5评分变量及术后并发症信息,构建mFI-5。根据mFI-5评分分为衰弱组(mFI-5≥2分)与非衰弱组(mFI-5<2分)。术后并发症包括术后谵妄、脑卒中、肺炎、深静脉血栓及肺不张。比较2组患者术后并发症的发生情况。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。采用二分类多因素logistic回归分析探讨衰弱对全髋关节置换患者术后并发症的预测作用。结果 衰弱组190例(29.73%),非衰弱组449例(70.27%)。2组患者性别、美国麻醉医师协会分级及麻醉方式比较,差异均有统计学意义(均P<0.05)。衰弱组在慢性阻塞性肺疾病或慢性肺炎病史、非独立功能状态、2型糖尿病史、术前30 d内充血性心力衰竭史以及需要药物治疗的高血压病史五个方面的发生情况均明显高于非衰弱组,差异均有统计学意义[27例(14.21%)和9例(2.00%),132例(69.47%)和43例(9.58%),92例(48.42%)和23例(5.12%),2例(1.05%)和0(0.00),176例(92.63%)和177例(39.42%);均P<0.001]。衰弱组患者总并发症发生率明显高于非衰弱组,差异有统计学意义[94例(49.47%)和20例(4.45%);P<0.001]。多因素logistic回归分析显示,衰弱组患者出现术后并发症的风险是非衰弱组倍12.23倍(OR=12.23,95%CI 6.51~23.98;P=0.002),差异有统计学意义(P<0.05)。衰弱是术后谵妄(OR=10.32,95%CI 5.63~23.79;P=0.022)、脑卒中(OR=12.24,95%CI 5.09~69.01;P<0.001)、肺部感染(OR=5.88,95%CI 2.31~23.91;P<0.001)和DVT(OR=27.61,95%CI 3.02~78.24;P=0.034)的独立危险因素。结论 mFI-5是预测老年全髋关节置换患者术后并发症的有效评估工具,mFI-5≥2分可作为预测术后并发症的有效指标。

Objective To explore the clinical value of the 5-factor modified frailty index(mFI-5)in predicting complications after total hip arthroplasty in the elderly with a view to providing a reference for patients with a comprehensive intervention during the peri-operative period.Methods A retrospective analysis was made of the clinical data of 639 patients aged≥65 years,who underwent total hip arthroplasty in the Department of Orthopedics of the First Medical Center of the Chinese People′s Liberation Army General Hospital from January 2014 to August 2019.mFI-5 was calculated by collecting patient demographics,surgery-related information,mFI-5 scoring variables,and postoperative complications.According to the mFI-5 score,the patients were divided into a frail group(mFI-5≥2 points)and a non-frail group(mFI-5<2 points).Postoperative complications included postoperative delirium,stroke,pneumonia,deep vein thrombosis,and atelectasis.The two groups were compared in the incidence of postoperative complications.SPSS 26.0 was used for statistical analysis.Intergroup comparison was performed using t test orχ^(2) test depending on data type.Multivariate logistic regression analysis was used to investigate the predictive effect of frailty on postoperative complications in patients with total hip arthroplasty.Results There were 190 cases(29.73%)in the frail group and 449 cases(70.27%)in the non-frail group.There were significant differences in gender,American Society of Anesthesiologists classification and anesthesia method between the two groups(all P<0.05).The frail group had significantly higher incidences in five aspects:history of chronic obstructive pulmonary disease or chronic pneumonia[27(14.21%)vs 9(2.00%)],dependent functional status[132(69.47%)vs 43(9.58%)],history of type 2 diabetes mellitus[92(48.42%)vs 23(5.12%)],history of congestive heart failure within 30 d before surgery[2(1.05%)vs 0(0.00)],and history of hypertension requiring drug treatment[176(92.63%)vs 177(39.42%);all P<0.001].The incidence of total complications in the frail group was significantly higher than that in the non-frail group[94(49.47%)vs 20(4.45%);P<0.001].Multivariate logistic regression analysis showed that the risk of postoperative complications in the frail group was 12.23 times that of the non-frail group(OR=12.23,95%CI 6.51-23.98;P=0.002),and the difference was statistically significant(P<0.05).Frailty was independent risk factors of delirium(OR=10.32,95%CI 5.63-23.79;P=0.022),stroke(OR=12.24,95%CI 5.09-69.01;P<0.001),pulmonary infection(OR=5.88,95%CI 2.31-23.91;P<0.001)and DVT(OR=27.61,95%CI 3.02-78.24;P=0.034).Conclusion mFI-5 is an effective tool for predicting postoperative complications in the elderly patients with total hip arthroplasty,mFI-5≥2 being an important indicator to predict postoperative complications.