在急诊剖腹手术中，虚弱会影响所有老年成人群体的预后

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-08-21 DOI:10.1016/j.amjsurg.2025.116571

Jefferson A. Proaño-Zamudio, Yasmin Arda, Teresia M. Perkins, Ikemsinachi C. Nzenwa, Dias Argandykov, Wardah Rafaqat, Charudutt N. Paranjape, George C. Velmahos, Haytham M.A. Kaafarani, John O. Hwabejire

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引用次数: 0

摘要

背景：在接受外科急诊的老年人中，虚弱对术后并发症的定量影响尚不清楚。方法采用2013-2019ACS-NSQIP数据库，筛选年龄≥65岁的急诊剖腹手术患者。使用改良的衰弱指数-5因子（mFI-5）测量衰弱程度。我们检查了30天死亡率、出院回家、术后并发症和意外再入院。多变量逻辑回归检验了虚弱和结果之间的关系。结果共纳入52356例患者。中位年龄为76岁（70-82岁）。大多数患者（68%）的mFI-5评分在0.2 - 0.5之间。较高的衰弱指数与较高的死亡率和较短的生存期相关（log-rank p < 0.001）。在多变量分析中，较高的虚弱指数与死亡率增加、肺炎、尿路感染、呼吸衰竭、急性肾损伤和再入院呈线性相关。结论虚弱程度的增加不仅会增加术后不良预后的风险，而且会增加出院后功能进一步丧失和恶化的风险。

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Frailty impacts outcomes for all older adult age groups in emergency laparotomy

Background

The quantitative effect of frailty on post-operative complications in older adults undergoing surgical emergencies is not well understood.

Methods

The 2013-2019ACS-NSQIP database was used to identify emergency laparotomy patients≥65 years. Frailty was measured using the modified-frailty-index-5 factors (mFI-5). We examined 30-day mortality, discharge to home, post-operative complications and unplanned readmissions. Multivariable logistic regression examined the association between frailty and outcomes.

Results

52,356 patients were included. The median age was 76(70–82) years. Most patients (68 %) had an mFI-5 score between 0.2 and 0.5. Higher frailty index was associated with higher mortality and shorter length of survival (log-rank p < 0.001). On multivariable analysis, a higher frailty index was associated with increased mortality, pneumonia, urinary tract infection, respiratory failure, acute kidney injury, and readmission in a linear fashion.

Conclusion

Increasing levels of frailty not only increase the risk of adverse post-operative outcomes, but also increase the risk of further functional loss and deterioration after discharge.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.