P May-Miller, Map Ligthart, A R Darbyshire, S Rahman, P H Pucher, N J Curtis, M A West
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引用次数: 0
Abstract
Introduction: Emergency surgical admissions represent the most unwell patients admitted to any hospital. Frailty and body composition independently identify risk of adverse outcomes but are seldom combined to predict outcomes in emergency patients. We aim to determine the relationships between frailty, body composition analyses (BCA) and mortality in an undifferentiated emergency general surgical patient population.
Method: A prospective, multicentre observational cohort study of patients admitted with emergency surgical pathology was conducted in eight hospitals. BCA were performed at L3 vertebrae using computed tomography images to quantify sarcopenia and myosteatosis. Sex-specific BCA cut-off values were determined by our previous study. Reported Edmonton Frail Scale (REFS) values ≥8 identified frailty. The primary outcomes were all-cause 30-day and 1-year mortality. Multivariable logistic regression was utilised to explore predictive relationships between frailty, BCA, mortality and independent discharge.
Results: A total of 194 patients were included; 24% were frail, 25% were sarcopenic and 23% myosteatotic. Some 61% of patients underwent an emergency laparotomy. Frail patients were more likely to be sarcopenic (20.4% vs 40.4%; p = 0.011) and myosteatotic (27.2% vs 51.1%; p = 0.004). Thirty-day and 1-year mortality was 5.2% and 15.5%, respectively; 30-day mortality was two times higher in the frail group (4.1% vs 8.5%; p = 0.414), and three times higher at 1 year (10.2% vs 31.9%; p = 0.001). Age (odds ratio [OR] 1.06; p = 0.001), sarcopenia (OR 2.88; p = 0.047) and frailty (OR 4.13; p = 0.001) were associated with 1-year mortality. Only 55.3% of frail patients were discharged home independently compared with 88.4% non-frail patients (p < 0.001). One-year mortality was greater in those with frailty and/or BCA abnormalities than in those without (28.8% vs 9.6%; p = 0.003).
Conclusion: Frailty, sarcopenia and myosteatosis contribute significantly to adverse outcomes.
期刊介绍：
The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November.
The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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