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

IF 3.6 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Aditya Safaya, Ahsan Zil-E-Ali, Kristine L So, Faisal Aziz
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引用次数: 0

摘要

目的:评估术前认知障碍/痴呆(CI/D)和近期跌倒史与bb0 ~ 65岁血管手术患者术后30天预后的关系。方法:查询美国外科医师学会国家手术质量改进计划(ACS-NSQIP)中2021年年龄在0 ~ 65岁之间的血管外科患者,记录第一年CI/D和跌倒史。患者被分为两组:没有CI/D或跌倒的患者(第一组)和没有CI/D或跌倒的患者(第二组)。结果包括30天死亡率、非计划返回手术室(OR)、非家庭出院和住院时间。多变量逻辑回归用于确定独立关联,调整人口统计学和临床协变量。结果:7057例患者中,458例(6.5%)有CI/D或跌倒史。与I组相比,II组患者年龄更大(81.7岁对74.3岁),更有可能出现功能依赖(34.7%对5.4%),并且有更高的合并症负担。II组的预后明显更差:30天死亡率(7.4%比2.1%)、重返手术室(12.0%比7.7%)和非家庭出院(35.6%比11.0%)(所有结论:在老年血管手术患者中,术前CI/D和跌倒是显著的,是术后死亡率和发病率的独立预测因子。这些易于识别的临床特征应纳入术前风险评估,以改善手术决策和资源分配。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
CiteScore
7.70
自引率
18.60%
发文量
1469
审稿时长
54 days
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.
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