修正虚弱指数作为预测脊柱转移术后并发症发生率和严重程度的新指标。

IF 4.9 1区 医学 Q1 ORTHOPEDICS
Tomoya Matsuo, Yutaro Kanda, Yoshitada Sakai, Takashi Yurube, Yoshiki Takeoka, Kunihiko Miyazaki, Ryosuke Kuroda, Kenichiro Kakutani
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引用次数: 0

摘要

目的:作为预测手术结果的一个因素,虚弱已经引起了人们的关注。然而,在脊柱转移手术中,虚弱与术后并发症的关系仍然存在争议。因此,我们设计了一项前瞻性研究,以虚弱为重点,阐明术后并发症的危险因素。方法:我们前瞻性分析了2015年6月至2021年12月期间接受姑息性手术的241例脊柱转移患者。术后并发症采用Clavien-Dindo分级法评估;评分≥II级定义为并发症。收集有关人口统计学(年龄、性别、BMI和原发癌症)和术前临床因素(新Katagiri评分、Frankel分级、运动状态、放疗、化疗、脊柱不稳定肿瘤评分、改良脆性指数-11 (mFI)、糖尿病和血清白蛋白水平)的数据。采用单因素和多因素分析确定术后并发症的危险因素(p < 0.05)。结果:总的来说,241例患者中有47例(19.5%)发生了57例术后并发症。最常见的并发症是伤口感染/裂开、尿路感染和肺炎。单因素分析发现术前放疗(p = 0.028)、mFI (p < 0.001)、失血量≥500 ml (p = 0.016)、术前分子靶向药物(p = 0.030)是潜在的危险因素。从受试者工作特征曲线来看,mFI的临床最佳临界值为0.27(敏感性为46.8%;特异性,79.9%)。多因素分析确定mFI≥0.27(优势比(OR) 2.94 (95% CI 1.44 ~ 5.98);p = 0.003)和术前放疗(OR 2.11 (95% CI 1.00 ~ 4.46);P = 0.049)为显著危险因素。特别是尿路感染(p = 0.012)和肺炎(p = 0.037)与mFI≥0.27相关。术后并发症严重程度与mFI呈正相关(p < 0.001)。结论:mFI是预测脊柱转移手术并发症发生率和严重程度的有效工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Modified Frailty Index as a novel predictor for the incidence and severity of postoperative complications after spinal metastases surgery.

Aims: Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty.

Methods: We prospectively analyzed 241 patients with spinal metastasis who underwent palliative surgery from June 2015 to December 2021. Postoperative complications were assessed by the Clavien-Dindo classification; scores of ≥ Grade II were defined as complications. Data were collected regarding demographics (age, sex, BMI, and primary cancer) and preoperative clinical factors (new Katagiri score, Frankel grade, performance status, radiotherapy, chemotherapy, spinal instability neoplastic score, modified Frailty Index-11 (mFI), diabetes, and serum albumin levels). Univariate and multivariate analyses were developed to identify risk factors for postoperative complications (p < 0.05).

Results: Overall, 57 postoperative complications occurred in 47 of 241 (19.5%) patients. The most common complications were wound infection/dehiscence, urinary tract infection, and pneumonia. Univariate analysis identified preoperative radiotherapy (p = 0.028), mFI (p < 0.001), blood loss ≥ 500 ml (p = 0.016), and preoperative molecular targeted drugs (p = 0.030) as potential risk factors. From the receiver operating characteristic curve, the clinically optimal cut-off value of mFI was 0.27 (sensitivity, 46.8%; specificity, 79.9%). Multivariate analysis identified mFI ≥ 0.27 (odds ratio (OR) 2.94 (95% CI 1.44 to 5.98); p = 0.003) and preoperative radiotherapy (OR 2.11 (95% CI 1.00 to 4.46); p = 0.049) as significant risk factors. In particular, urinary tract infection (p = 0.012) and pneumonia (p = 0.037) were associated with mFI ≥ 0.27. Furthermore, the severity of postoperative complications was positively correlated with mFI (p < 0.001).

Conclusion: The mFI is a useful tool to predict the incidence and the severity of postoperative complications in spinal metastases surgery.

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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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