改良衰弱指数在预测老年腹腔镜结直肠癌手术患者术后并发症中的应用
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摘要
目的评估改良衰弱指数(mFI)在预测老年腹腔镜结直肠癌手术患者术后并发症中的应用。方法收集广州市第一人民医院2010年1月至2017年12月行腹腔镜结直肠癌手术的老年患者415例,依据患者术前mFI评分分为无衰弱组(mFI≤0.27,373例)、衰弱组(mFI> 0.27,42例),并对两组患者人口统计学、手术相关数据和术后并发症等指标进行统计分析。结果 10.1%的患者被评估为衰弱。衰弱组患者在住院天数、术后并发症及术后30 d死亡率上均与非衰弱组患者存在统计学差异。对术后并发症的多因素分析显示mFI是影响术后并发症的独立危险因素。结论 mFI过高是预测老年结直肠癌患者术后并发症发生的重要指标,术前对老年结直肠癌患者患者进行mFI评分有助于为临床诊疗提供合理依据,降低术后并发症发生率。
Objective To evaluate the application of modified frailty index(mFI)in predicting postoperative complications in aged patients after laparoscopic colorectal cancer surgery. Methods 415 aged patients who underwent laparoscopic colorectal cancer surgery in Guangzhou First People′s Hospital from January 2010 to December 2017 were divided into two groups according to their preoperative mFI scores:the non-frail group(mFI≤0.27,373 cases)and the frail group(mFI > 0.27,42 cases). The two groups were compared in demography,surgical data and postoperative complications. Results 10.1% of the patients were evaluated for frail. There were significant differences in length of stay,postoperative complications and 30-day mortality between the frail group and the non-frail group. Multivariate analysis of postoperative complications showed that mFI was an independent risk factor for postoperative complications. Conclusions High mFI is an important predictor of postoperative complications in aged patients with colorectal cancer. Preoperative mFI score in aged patients with colorectal cancer can provide a reasonable basis for clinical diagnosis and treatment and reduce the incidence of postoperative complications.
Objective To evaluate the application of modified frailty index(mFI)in predicting postoperative complications in aged patients after laparoscopic colorectal cancer surgery. Methods 415 aged patients who underwent laparoscopic colorectal cancer surgery in Guangzhou First People′s Hospital from January 2010 to December 2017 were divided into two groups according to their preoperative mFI scores:the non-frail group(mFI≤0.27,373 cases)and the frail group(mFI > 0.27,42 cases). The two groups were compared in demography,surgical data and postoperative complications. Results 10.1% of the patients were evaluated for frail. There were significant differences in length of stay,postoperative complications and 30-day mortality between the frail group and the non-frail group. Multivariate analysis of postoperative complications showed that mFI was an independent risk factor for postoperative complications. Conclusions High mFI is an important predictor of postoperative complications in aged patients with colorectal cancer. Preoperative mFI score in aged patients with colorectal cancer can provide a reasonable basis for clinical diagnosis and treatment and reduce the incidence of postoperative complications.
引文
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[22] CHO H,YOSHIKAWA T,OBA M S,et al. Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk:the Adjuvant Exercise for General Elective Surgery(AEGES)study group[J]. Ann Surg Oncol,2014,21(6):2044-2050.
[2] HOOGENDIJK E O,THEOU O,ROCKWOOD K,et al. Development and validation of a frailty index in the longitudinal aging study amsterdam[J]. Aging Clin Exp Res,2017,29(5):927-933.
[3] ROCKWOOD K,MITNITSKI A,HOWLETT S E. Frailty:Scaling from cellular deficit accumulation?[J]. Interdiscip Top Gerontol Geriatr,2015,41:1-14.
[4] RUIZ J G,PRIYADARSHNI S,RAHAMAN Z,et al. Validation of an automatically generated screening score for frailty:the care assessment need(CAN)score[J]. BMC Geriatr,2018,18(1):106.
[5] VELANOVICH V,ANTOINE H,SWARTZ A,et al. Accumulating deficits model of frailty and postoperative mortality and morbidity:Its application to a national database[J]. J Surg Res,2013,183(1):104-110.
[6] ROCKWOOD K,ANDREW M,MITNITSKI A. A comparison of two approaches to measuring frailty in elderly people[J]. J Gerontol A Biol Sci Med Sci,2007,62(7):738-743.
[7] MITNITSKI A B,MOGILNER A J,ROCKWOOD K. Accumulation of deficits as a proxy measure of aging[J]. ScientificWorldJournal,2001,1:323-336.
[8] TSIOURIS A,HAMMOUD Z T,VELANOVICH V,et al. A modified frailty index to assess morbidity and mortality after lobectomy[J]. J Surg Res,2013,183(1):40-46.
[9] FARHAT J S,VELANOVICH V,FALVO A J,et al. Are the frail destined to fail? Frailty index as predictor of surgical mor bidity and mortality in the elderly[J]. J Trauma Acute Care Surg,2012,72(6):1526-1530,1530-1531.
[10] KARAM J,TSIOURIS A,SHEPARD A,et al. Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients[J]. Ann Vasc Surg,2013,27(7):904-908.
[11] ALI R,SCHWALB J M,NERENZ D R,et al. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery[J]. J Neurosurg Spine,2016,25(4):537-541.
[12] ROBINSON T N,WU D S,POINTER L,et al. Simple frailty score predicts postoperative complications across surgical specialties[J]. Am J Surg,2013,206(4):544-550.
[13] KENNEDY C C,IOANNIDIS G,ROCKWOOD K,et al. A Frailty Index predicts 10-year fracture risk in adults age 25years and older:results from the Canadian Multicentre Osteoporosis Study(CaMos)[J]. Osteoporos Int,2014,25(12):2825-2832.
[14] LEE D H,BUTH K J,MARTIN B J,et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery[J]. Circulation,2010,121(8):973-978.
[15] RODRIGUES M K,MARQUES A,LOBO D,et al. Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery[J]. Arq Bras Cardiol,2017,109(4):299-306.
[16] SAXTON A,VELANOVICH V. Preoperative frailty and quality of life as predictors of postoperative complications[J]. Ann Surg,2011,253(6):1223-1229.
[17] HUISINGH-SCHEETZ M,WALSTON J. How should older adults with cancer be evaluated for frailty?[J]. J Geriatr Oncol,2017,8(1):8-15.
[18] RUIZ M,RESKE T,CEFALU C,et al. Management of elderly and frail elderly cancer patients:the importance of comprehensive geriatrics assessment and the need for guidelines[J]. Am J Med Sci,2013,346(1):66-69.
[19] OBEID N M,AZUH O,REDDY S,et al. Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program:exploring frailty and aggressive laparoscopic approaches[J]. J Trauma Acute Care Surg,2012,72(4):878-883.
[20] LOUWERS L,SCHNICKEL G,RUBINFELD I. Use of a simplified frailty index to predict Clavien 4 complications and mortality after hepatectomy:analysis of the National Surgical Quality Improvement Project database[J]. Am J Surg,2016,211(6):1071-1076.
[21] VERMILLION S A,HSU F C,DORRELL R D,et al. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients[J]. J Surg Oncol,2017,115(8):997-1003.
[22] CHO H,YOSHIKAWA T,OBA M S,et al. Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk:the Adjuvant Exercise for General Elective Surgery(AEGES)study group[J]. Ann Surg Oncol,2014,21(6):2044-2050.