术前衰弱状态与骨科大手术老年患者术后60 d发生死亡或行走障碍的关系

Association between frailty assessment and death or walking disorders within postoperative 60 days in elderly patients undergoing major orthopedic surgery

目的 探讨骨科大手术老年患者术前衰弱状态与术后60 d发生死亡或行走障碍的关系。方法 纳入2022年3月—2023年4月就诊于南通市第一人民医院并接受择期骨科大手术的老年患者441例,术前使用FRAIL量表评估衰弱状态,同时进行包括年龄校正的Charlson合并症指数(aCCI)评分等在内的术前基线资料的收集和评估。随访患者至术后60 d。观察主要结局指标(术后60 d发生死亡或行走障碍)、次要结局指标(首次下床时间、术后输血情况、术后谵妄情况、手术相关并发症的发生率、住院天数和住院费用)。采用多因素logistic回归分析术前衰弱状态与骨科大手术老年患者术后60 d发生死亡或行走障碍的关系,并筛选出术后60 d发生死亡或行走障碍的独立危险因素,通过受试者工作特征(ROC)曲线分析术前衰弱状态对术后60 d发生死亡或行走障碍的预测价值。结果 441例患者中术前衰弱172例,衰弱发生率为39.0%。术前衰弱患者中有72例术后60 d发生死亡或者行走障碍,高于术前非衰弱患者(14例)和衰弱前患者(27例)(P均<0.05)。多因素logistic回归分析结果显示,术前衰弱是骨科大手术老年患者术后60 d发生死亡或行走障碍的独立危险因素(OR=3.269,95%CI:1.597~6.692,P=0.001)。术前衰弱预测骨科大手术老年患者术后60 d发生死亡或者行走障碍的ROC曲线下面积为0.692,灵敏度为63.7%,特异度为69.5%。结论 术前衰弱是骨科大手术老年患者术后60 d发生死亡或行走障碍的独立危险因素。

Objective To explore the association between preoperative frailty and death or walking disorders within postoperative 60 days in elderly patients undergoing major orthopedic surgery.Methods A total of 441 elderly patients who underwent elective orthopedic surgery at the First People's Hospital of Nantong from March 2022 to April 2023 were in⁃cluded in the study.Preoperative frailty status was evaluated using the FRAIL scale,and baseline data,including age ad⁃justed Charlson comorbidity index(aCCI)scores were collected and evaluated.Patients were followed up to 60 days after surgery.Observe the primary outcome measures(death or walking disorders occurring 60 days after surgery)and second⁃ary outcome measures(first time out of bed,postoperative blood transfusion status,postoperative delirium status,inci⁃dence of surgery related complications,length of hospital stay and hospitalization costs).Multivariate logistic regression was used to investigate the relationship between preoperative frailty status and the occurrence of death or walking disorders within 60 days after surgery.Independent risk factors for death or walking disorders within 60 days after surgery were iden⁃tified,and the predictive value of frailty for death or walking disorders within 60 days after surgery was analyzed using re⁃ceiver operating characteristic(ROC)curve.Results Out of 441 patients,172 had preoperative frailty,with a frailty in⁃cidence rate of 39.0%.Among preoperative frailty patients,72 cases experienced death or walking disorders within 60 days after surgery,which was higher than that of preoperative non frailty patients(14 cases)and pre frailty patients(27 cases)(both P<0.05).The results of multivariate logistic regression analysis showed that preoperative frailty was an inde⁃pendent risk factor for death or walking disorders within postoperative 60 days in elderly patients undergoing orthopedic sur⁃gery(OR=3.269,95%CI:1.597-6.692,P=0.001).The area under the ROC curve for predicting preoperative frailty and predicting death or walking disorders 60 days after surgery was 0.692,with a sensitivity of 63.7%and a specificity of 69.5%.Conclusions Preoperative frailty is an independent risk factor for death or walking disorders within postopera⁃tive 60 days in elderly patients undergoing major orthopedic surgery.