虚弱和低白蛋白血症在游离组织瓣重建中的综合风险预测能力:来自 NSQIP 数据库的 34,571 例患者的队列研究。

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-03-28 DOI:10.1002/micr.31156
Adriana C. Panayi MD, PhD, Leonard Knoedler, Dany Y. Matar BA, Jasmin Rühl BS, Sarah Friedrich PhD, Valentin Haug MD, Alen Palackic MD, Benjamin Thomas MD, Ulrich Kneser MD, PhD, Dennis P. Orgill MD, PhD, Gabriel Hundeshagen MD, MMS
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引用次数: 0

摘要

导言:身体虚弱的病人功能衰退会导致严重的发病率和死亡率。改良虚弱指数 5(mFI-5)是一种风险预测评分,已作为外科手术中基于合并症的量表得到验证。方法:我们开展了一项多中心、回顾性队列研究,并访问了 2008 年至 2021 年的 ACS 国家外科质量改进计划 (ACS-NSQIP)。我们确定了所有接受 FFR 的成年患者(≥18 岁)。我们提取了围手术期数据和实验室值,包括白蛋白。我们进行了多变量线性和逻辑回归分析,以确定独立的风险预测因素。主要结果包括死亡率、住院时间、再次手术、内外科并发症以及术后30天内的出院去向:研究共纳入了 34571 名患者,平均年龄为 53.9 岁(标准差 [SD] 12.2),平均体重指数 (BMI) 为 28.8(标准差 6.1)。这些患者中有 7484 名男性(21.6%),22363 名患者(64.7%)没有虚弱症状(mFI = 0)。此外,9466 名患者的虚弱评分为 1 分(占 27.4%),2505 名患者的评分为 2 分(占 7.2%),226 名患者的评分为 3 分(占 0.7%),11 名患者的评分为 4 分或以上(占 0.0%)。有 16250 名患者(47.0%)的白蛋白水平可用,其中 1334 人(8.2%)患有低白蛋白血症。回归分析表明,较高的 mFI 分数是任何并发症、手术并发症和内科并发症的独立预测因素,也是再次手术率、非计划再入院率和住院时间延长率增加的独立预测因素。低白蛋白血症可独立预测任何并发症、手术并发症和内科并发症,以及更高的死亡率、再次手术率和更长的住院时间。当同时考虑虚弱和白蛋白水平(mFI-5 和白蛋白)时,我们发现这种综合评估能更准确地预测所有主要结果(任何并发症、内科和外科并发症、死亡率和再次手术)。此外,我们的分析还发现血清白蛋白水平与 mFI 评分之间存在微弱的负相关(Spearman R:-.1;P总之,这项队列研究强调了低白蛋白血症与不良术后结果之间的关系,包括那些与虚弱并无直接关系的不良后果。同时,较高的 mFI 分数可独立预测与低白蛋白血症无关的结果。基于这些发现,我们建议对接受 FFR 的患者同时考虑血清白蛋白水平和虚弱程度。这种围手术期算法有助于提供更加个性化的规划,包括多学科护理和术前、术后康复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database

Introduction

Significant morbidity and mortality are hallmarks of the functional decline seen in physically frail patients. The modified frailty index 5 (mFI-5) represents a risk predictor score that has been validated as a comorbidity-based scale in surgery. Serum albumin levels of <3.5 g/dL (hypoalbuminemia) have also been implicated with poor postoperative outcomes. However, the association between these two parameters remains to be investigated. We aimed to elucidate the interdependence of preoperative albumin levels and frailty, as evaluated by the mFI-5 score, and its reliability to prognosticate postoperative results in free flap reconstruction (FFR).

Methods

We conducted a multicenter, retrospective cohort study and accessed the ACS National Surgical Quality Improvement Program (ACS-NSQIP) from 2008 to 2021. We identified all adult patients (≥18 years of age) who underwent a FFR. We extracted perioperative data and lab values including albumin. Multivariable linear and logistic regression analyses were performed to identify independent risk predictors. Main outcomes involved mortality, length of hospital stay, reoperation, medical and surgical complications, and discharge destination within the 30-day postoperative period.

Results

A total of 34,571 patients were included in the study, with an average age of 53.9 years (standard deviation [SD] 12.2) and an average body mass index (BMI) of 28.8 (SD 6.1). Of these patients, 7484 were male (21.6%), whereas 22,363 (64.7%) had no frailty (mFI = 0). Additionally, 9466 patients had a frailty score of 1 (27.4%), 2505 had a score of 2 (7.2%), 226 had a score of 3 (0.7%), and 11 had a score of 4 or higher (0.0%). Albumin levels were available for 16,250 patients (47.0%), and among them, 1334 (8.2%) had hypoalbuminemia. Regression analyses showed that higher mFI scores were independent predictors of any, surgical, and medical complications, as well as increased rates of reoperations, unplanned readmissions, and prolonged hospital stays. Hypoalbuminemia independently predicted any, surgical, and medical complications, and higher mortality, reoperation, and longer hospital stay. When both frailty and albumin levels (mFI-5 and albumin) were considered together, this combined assessment was found to be a more accurate predictor of all major outcomes (any, medical and surgical complications, mortality, and reoperation). Further, our analysis identified a weak negative correlation between serum albumin levels and mFI scores (Spearman R: −.1; p < .0001).

Conclusion

In conclusion, this cohort study highlights the association of hypoalbuminemia with adverse postoperative outcomes, including those not directly related to frailty. Simultaneously, higher mFI scores independently predicted outcomes not associated with hypoalbuminemia. Stemming from these findings, we recommend considering both serum albumin levels and frailty in patients receiving FFR. This perioperative algorithm may help provide more individualized planning including multidisciplinary care and pre and posthabilitation.

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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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