Vincent D. Salvador, Jaime Abraham Perez, Paige W. Hudec, Eiran Z. Gorodeski, Thomas JosephO'Neill IV
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We tracked hospital- and ICU-length of stay, duration of mechanical ventilator use, renal replacement therapy (RRT), and survival.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>History of falls was associated with prolonged mechanical support (mean difference: +1.5 days, <i>p</i> = 0.002), prolonged ICU stay (mean difference: +13 days, <i>p</i> = 0.03), and prolonged hospital stay (mean difference: +17 days, <i>p</i> = 0.03). Patients with a history of falls also had a higher rate of needing RRT in the 90 days following surgery (adjusted HR: 4.7, 95% CI 1.1–20, <i>p</i> = 0.035). 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引用次数: 0
摘要
对于接受外科先进治疗的晚期心力衰竭（HF）患者来说，虚弱预示着更糟糕的结果。跌倒是身体虚弱的特征，但跌倒史是否能预测术后风险尚不清楚。我们假设单项跌倒筛查与较差的结果相关。方法：我们对2020年至2023年在我院接受原位心脏移植（OHT）或左心室辅助装置（LVAD）植入的所有患者进行回顾性研究。我们感兴趣的主要暴露是跌倒，通过在手术前12个月或更短时间内的护理问卷进行评估。我们追踪了住院和重症监护病房的住院时间、机械呼吸机使用时间、肾脏替代治疗（RRT）和生存率。结果跌倒史与机械支持延长（平均差值+1.5天，p = 0.002）、ICU住院时间延长（平均差值+13天，p = 0.03）、住院时间延长（平均差值+17天，p = 0.03）相关。有跌倒史的患者在手术后90天内需要RRT的比例也较高（调整后危险度：4.7,95% CI 1.1-20, p = 0.035）。两组患者的生存率没有差异。结论在接受OHT或LVAD治疗的晚期HF患者中，简单的单项护理跌倒评估与临床相关的较差预后相关。
A Simple One-Item Nursing Falls Assessment Predicts Outcomes for Patients With Stage D Heart Failure Undergoing Surgical Advanced Therapies
Introduction
Frailty portends worse outcomes for patients with advanced heart failure (HF) undergoing surgical advanced therapies. Falls are characteristic of frailty, but it is unknown if the history of falls predicts post-operative risk. We hypothesized that a one-item fall screening is associated with worse outcomes.
Methods
We conducted a retrospective study of all patients undergoing orthotopic heart transplantation (OHT) or left ventricular assist device (LVAD) implantation at our institution between 2020 and 2023. Our primary exposure of interest was falls, as assessed by a nursing questionnaire within 12 months or less prior to surgery. We tracked hospital- and ICU-length of stay, duration of mechanical ventilator use, renal replacement therapy (RRT), and survival.
Results
History of falls was associated with prolonged mechanical support (mean difference: +1.5 days, p = 0.002), prolonged ICU stay (mean difference: +13 days, p = 0.03), and prolonged hospital stay (mean difference: +17 days, p = 0.03). Patients with a history of falls also had a higher rate of needing RRT in the 90 days following surgery (adjusted HR: 4.7, 95% CI 1.1–20, p = 0.035). There were no differences in survival between the two groups.
Conclusion
Among patients with advanced HF undergoing OHT or LVAD, a simple one-item nursing falls assessment is associated with clinically relevant worse outcomes.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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