Frailty and decisional regret after elective noncardiac surgery: a multicentre prospective cohort study

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-09-03 DOI:10.1016/j.bja.2024.08.001

Yonathan Agung , Emily Hladkowicz , Laura Boland , Husein Moloo , Luke T. Lavallée , Manoj M. Lalu , Daniel I. McIsaac

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Abstract

Background

Frailty is associated with morbidity and mortality after surgery. The association of frailty with decisional regret is poorly defined. Our objective was to estimate the association of preoperative frailty with decisional regret status in the year after surgery.

Methods

We conducted a secondary analysis of a prospective, multicentre cohort study of patients aged ≥65 years who underwent elective noncardiac surgery. Decisional regret about having undergone surgery was ascertained at 30, 90, and 365 (primary time point) days after surgery using a 3-point ordinal scale. Bayesian ordinal logistic regression was used to estimate the association of frailty with decisional regret, adjusted for surgery type, age, sex, and mental health conditions. Subgroup and sensitivity analyses were conducted.

Results

We identified 669 patients; 293 (43.8%) lived with frailty. At 365 days after surgery, the unadjusted odds ratio (OR) associating frailty with greater decisional regret was 2.21 (95% credible interval [CrI] 0.98–5.09; P(OR>1)=0.97), which was attenuated after confounder adjustment (adjusted OR 1.68, 95% CrI 0.84–3.36; P(OR>1)=0.93). Similar results were estimated at 30 and 90 days. Additional adjustment for baseline comorbidities and disability score substantially altered the OR at 365 days (0.89, 95% CrI 0.37–2.12; P(OR>1)=0.39). There was a high probability that surgery type was an effect modifier (non-orthopaedic: OR 1.90, 95% CrI 1.00–3.59; P(OR>1)=0.98); orthopaedic: OR 0.87, 95% CrI 0.41–1.91; P(OR>1)=0.36).

Conclusions

Among older surgical patients, there appears to be a complex association with frailty and decisional regret, with substantial heterogeneity based on assumed causal pathways and surgery type. Future studies are required to untangle the complex interplay between these factors.

查看原文本刊更多论文

择期非心脏手术后的虚弱与决策后悔：一项多中心前瞻性队列研究。

背景：虚弱与手术后的发病率和死亡率有关。虚弱与决策后悔之间的关系尚不明确。我们的目的是估算术前虚弱与术后一年内决策后悔状态的关系：我们对一项前瞻性多中心队列研究进行了二次分析，研究对象是年龄≥65 岁、接受择期非心脏手术的患者。在术后30天、90天和365天（主要时间点），我们使用3点序数量表确定了患者对接受手术的决定性后悔程度。贝叶斯序数逻辑回归用于估计虚弱与决定性后悔之间的关系，并对手术类型、年龄、性别和精神健康状况进行了调整。我们还进行了分组分析和敏感性分析：我们确定了 669 名患者，其中 293 人（43.8%）患有虚弱症。术后 365 天，未调整的体弱与决策后悔相关的几率比（OR）为 2.21（95% 可信区间 [CrI] 0.98-5.09；P(OR>1)=0.97），调整混杂因素后，该几率比减小（调整后的几率比为 1.68，95% 可信区间 [CrI] 0.84-3.36；P(OR>1)=0.93）。30 天和 90 天的估计结果类似。对基线合并症和残疾评分的额外调整大大改变了 365 天的 OR（0.89，95% CrI 0.37-2.12；P（OR>1）=0.39）。手术类型极有可能是影响因子（非骨科：OR 1.90，95% CrI 1.00-3.59；P（OR>1）=0.98）；骨科：OR 0.87，95% CrI 0.41-1.91；P（OR>1）=0.36）：在老年手术患者中，虚弱与决策后悔之间似乎存在着复杂的联系，根据假定的因果途径和手术类型存在着很大的异质性。未来的研究需要解开这些因素之间复杂的相互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.