Aditya Safaya, Ahsan Zil-E-Ali, Kristine L So, Faisal Aziz
{"title":"有认知障碍或跌倒史的老年人群接受血管手术后的不良结果","authors":"Aditya Safaya, Ahsan Zil-E-Ali, Kristine L So, Faisal Aziz","doi":"10.1016/j.jvs.2025.07.034","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of preoperative cognitive impairment/dementia (CI/D) and recent fall history with 30-day postoperative outcomes in patients aged >65 years undergoing vascular surgery.</p><p><strong>Methods: </strong>American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for vascular surgery patients >65 years in 2021, the first year CI/D and fall history were captured. Patients were categorized into two groups: those without CI/D or falls (Group I) and those with either or both (Group II). Outcomes included 30-day mortality, unplanned return to operating room (OR), non-home discharge, and length of stay. Multivariable logistic regression was used to identify independent associations, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Among 7,057 patients, 458 (6.5%) had CI/D or fall history. Compared to Group I, Group II patients were older (81.7 vs. 74.3 years), more likely to be functionally dependent (34.7% vs. 5.4%), and had higher comorbidity burdens. Group II experienced significantly worse outcomes: 30-day mortality (7.4% vs. 2.1%), return to OR (12.0% vs. 7.7%), and non-home discharge (35.6% vs. 11.0%) (all p<0.001). On adjusted analysis, CI/D or falls were independently associated with increased odds of mortality (AOR 2.08, 95% CI 1.28-3.37), return to OR (AOR 1.49, CI 1.06-2.22), and non-home discharge (AOR 2.28, CI 1.77-2.93). Isolated CI/D was associated with mortality (AOR 2.26, CI 1.14-4.51), while falls alone were associated with return to OR (AOR 1.62, CI 1.04-2.52) and non-home discharge (AOR 2.89, CI 2.09-3.99).</p><p><strong>Conclusions: </strong>In geriatric vascular surgery patients, preoperative CI/D and falls are significant, independent predictors of postoperative mortality and morbidity. These readily identifiable clinical features should be incorporated into preoperative risk assessments to improve surgical decision-making and resource allocation.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Adverse Postoperative Outcomes in Geriatric Population with a History of Cognitive Impairment or Falls Undergoing Vascular Surgery.\",\"authors\":\"Aditya Safaya, Ahsan Zil-E-Ali, Kristine L So, Faisal Aziz\",\"doi\":\"10.1016/j.jvs.2025.07.034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess the association of preoperative cognitive impairment/dementia (CI/D) and recent fall history with 30-day postoperative outcomes in patients aged >65 years undergoing vascular surgery.</p><p><strong>Methods: </strong>American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for vascular surgery patients >65 years in 2021, the first year CI/D and fall history were captured. Patients were categorized into two groups: those without CI/D or falls (Group I) and those with either or both (Group II). Outcomes included 30-day mortality, unplanned return to operating room (OR), non-home discharge, and length of stay. Multivariable logistic regression was used to identify independent associations, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Among 7,057 patients, 458 (6.5%) had CI/D or fall history. Compared to Group I, Group II patients were older (81.7 vs. 74.3 years), more likely to be functionally dependent (34.7% vs. 5.4%), and had higher comorbidity burdens. Group II experienced significantly worse outcomes: 30-day mortality (7.4% vs. 2.1%), return to OR (12.0% vs. 7.7%), and non-home discharge (35.6% vs. 11.0%) (all p<0.001). On adjusted analysis, CI/D or falls were independently associated with increased odds of mortality (AOR 2.08, 95% CI 1.28-3.37), return to OR (AOR 1.49, CI 1.06-2.22), and non-home discharge (AOR 2.28, CI 1.77-2.93). Isolated CI/D was associated with mortality (AOR 2.26, CI 1.14-4.51), while falls alone were associated with return to OR (AOR 1.62, CI 1.04-2.52) and non-home discharge (AOR 2.89, CI 2.09-3.99).</p><p><strong>Conclusions: </strong>In geriatric vascular surgery patients, preoperative CI/D and falls are significant, independent predictors of postoperative mortality and morbidity. These readily identifiable clinical features should be incorporated into preoperative risk assessments to improve surgical decision-making and resource allocation.</p>\",\"PeriodicalId\":17475,\"journal\":{\"name\":\"Journal of Vascular Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-07-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Vascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jvs.2025.07.034\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jvs.2025.07.034","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Adverse Postoperative Outcomes in Geriatric Population with a History of Cognitive Impairment or Falls Undergoing Vascular Surgery.
Objective: To assess the association of preoperative cognitive impairment/dementia (CI/D) and recent fall history with 30-day postoperative outcomes in patients aged >65 years undergoing vascular surgery.
Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for vascular surgery patients >65 years in 2021, the first year CI/D and fall history were captured. Patients were categorized into two groups: those without CI/D or falls (Group I) and those with either or both (Group II). Outcomes included 30-day mortality, unplanned return to operating room (OR), non-home discharge, and length of stay. Multivariable logistic regression was used to identify independent associations, adjusting for demographic and clinical covariates.
Results: Among 7,057 patients, 458 (6.5%) had CI/D or fall history. Compared to Group I, Group II patients were older (81.7 vs. 74.3 years), more likely to be functionally dependent (34.7% vs. 5.4%), and had higher comorbidity burdens. Group II experienced significantly worse outcomes: 30-day mortality (7.4% vs. 2.1%), return to OR (12.0% vs. 7.7%), and non-home discharge (35.6% vs. 11.0%) (all p<0.001). On adjusted analysis, CI/D or falls were independently associated with increased odds of mortality (AOR 2.08, 95% CI 1.28-3.37), return to OR (AOR 1.49, CI 1.06-2.22), and non-home discharge (AOR 2.28, CI 1.77-2.93). Isolated CI/D was associated with mortality (AOR 2.26, CI 1.14-4.51), while falls alone were associated with return to OR (AOR 1.62, CI 1.04-2.52) and non-home discharge (AOR 2.89, CI 2.09-3.99).
Conclusions: In geriatric vascular surgery patients, preoperative CI/D and falls are significant, independent predictors of postoperative mortality and morbidity. These readily identifiable clinical features should be incorporated into preoperative risk assessments to improve surgical decision-making and resource allocation.
期刊介绍:
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.