改良衰弱评估对行口腔鳞癌皮瓣重建术老年患者术后并发症的预测价值

The predictive value of modified frailty assessment tool for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma

目的:探讨改良衰弱评估对行口腔鳞癌皮瓣重建术老年患者术后并发症的预测价值。方法:回顾性分析2014年1月—2022年12月在上海交通大学医学院附属第九人民医院接受口腔鳞癌肿瘤切除并行游离皮瓣重建的老年患者(>60岁)的围术期资料。根据改良5项衰弱评估工具(5 modified frailty index,5-mFI),依照是否衰弱分为衰弱组(≥2分)和非衰弱组(<2分),统计术后短期并发症发生率,以明确衰弱是否与其相关。采用R 4.0.5软件包中的logistics回归分析确定与衰弱相关的术后并发症。结果:共纳入1 083例患者,其中376例(34.7%)发生术后并发症。纳入衰弱组235例(21.7%),非衰弱组848例(78.3%)。衰弱组在术后并发症发生率、重症监护室住院天数、术后住院天数方面均显著多于非衰弱组(P<0.05)。在校正性别、年龄、吸烟、饮酒情况等混杂因素后,多因素logistics回归显示,肺部并发症(OR=4.76,95%CI:3.32~6.83,P<0.001)、皮瓣并发症(OR=2.65,95%CI:1.57~4.42,P<0.001)、肾功能损伤(OR=3.31,95%CI:1.13~9.66,P<0.05)等与衰弱显著相关。结论:5-mFI评分与接受口腔鳞癌皮瓣重建手术的老年患者术后并发症显著相关,为临床工作提供了一个方便、简洁的评估工具。

PURPOSE:To explore the predictive value of modified frailty assessment for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma.METHODS:Retrospective analysis was performed on elderly patients(>60 years old) who underwent oral squamous cell carcinoma resection with free-flap reconstruction at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2014 to December 2022.The patients' perioperative data were collected.According to the 5 modified frailty index(5-mFI),the in-dividuals were grouped into frail(≥2 points) and non-frail(<2 points) group.The occurrence rate of short-term postoperative complication was calculated to determine the association between frailty and complications.Logistic regression analy-sis was applied to identify which postoperative complications were related to frailty with R 4.0.5 software package.RESULTS:A total of 1 083 patients were included.The rate of postoperative complications was 34.7%(376 cases).Among the patients,235 cases(21.7%) were classified as the frail group,while 848 cases(78.3%) were classified as the non-frail group.The frail group had a higher incidence of postoperative complications,longer stays in intensive-care unit and post-operative hospital,compared to the non-frail group,with significant difference(P<0.05).After adjusting for confounding factors including gender,age,smoking,and alcohol consumption,multiple logistic regression analysis revealed that pul-monary complications(OR=4.76,95%CI:3.32-6.83,P<0.001),flap complications(OR=2.65,95%CI:1.57-4.42,P<0.001),and acute kidney injury(OR=3.31,95%CI:1.13-9.66,P<0.05) were strongly correlated with frailty.CONCLUSIONS:The 5-mFI score is significantly correlated with postoperative complications in elderly patients undergoing flap reconstruc-tion surgery for oral squamous cell carcinoma,which provides a convenient and concise assessment tool for clinical work.