高龄患者颈动脉内膜切除术的安全性分析及其对衰弱的影响——一项国家手术质量改进计划分析

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY
Christine Y. Nguyen , Anthony V. Nguyen , Laura K. Reed , Jose M. Soto , Awais Z. Vance , Chitra K. Hamilton
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引用次数: 0

摘要

背景颈动脉狭窄的患病率随着年龄的增长而增加,颈动脉内膜切除术(CEA)是一种可能的治疗选择。然而,90多岁的老人术后并发症的风险很高,通常不被认为是手术的候选人。我们的目的是确定与接受CEA的90多岁老人术后心肌梗死(MI)、中风和30天内死亡相关的危险因素,并分析改良虚弱指数(mFI)在预测该人群不良结局方面的预测能力。材料和方法本研究是一项回顾性队列研究,研究对象为2015年至2019年接受CEA治疗的90岁 + 岁患者,使用的是经过验证的多机构国家外科质量改进计划(NSQIP)血管靶向登记。采用多变量logistic回归分析和确定与心肌梗死发生率、卒中发生率和手术后30天内死亡相关的因素。由功能依赖和呼吸困难组成的2因素mFI在预测这些并发症中的应用分别用单变量logistic回归进行检验。结果在191例符合研究标准的患者中,2.1 %发生脑卒中,3.7 %发生心肌梗死,3.7 %死亡。术前阿司匹林使用(OR 0.09, 95 % CI: 0.01-0.8, p = )。02)与较低的中风几率相关。功能状态(OR 14.1, 95 % CI: 1.4-151.0, p = )。02)和呼吸困难(或22.6,95 % CI: 2.1 - -309.3, p & lt; 。01)与较高的心肌梗死几率相关,而他汀类药物的使用(OR 0.07, 95 % CI: 0.007-0.5, p = )。0.01)与较低的几率相关。择期病例的死亡较少(OR 0.1, 95 % CI: 0.005-0.6, p = .04)。2因素mFI不能预测中风,但可以预测心肌梗死和死亡,优于现有的5因素mFI。结论在高选择性的老年人群中,CEA的风险谱是可以接受的。术前选择性使用阿司匹林和他汀类药物的功能独立、无呼吸困难的老年患者CEA后30天并发症的风险最低。功能依赖和呼吸困难是虚弱的合理替代指标,可能表明考虑CEA的90多岁老人并发症风险高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of safety of carotid endarterectomy in nonagenarians and the implications of frailty - A National surgical quality improvement program analysis

Background

Carotid artery stenosis prevalence increases with age, and carotid endarterectomy (CEA) is a possible treatment option. However, nonagenarians are at high risk of experiencing postoperative complications and are often not considered surgical candidates. We aimed to identify risk factors associated with postoperative myocardial infarction (MI), stroke, and death within 30 days for nonagenarians undergoing CEA and to analyze the predictive ability of modified frailty indices (mFI) in predicting adverse outcomes for this population.

Materials and methods

This was a retrospective cohort study of patients aged 90 + years who underwent CEA from 2015 to 2019 utilizing the validated multi-institutional National Surgical Quality Improvement Program (NSQIP) vascular targeted registry. Multivariable logistic regression was used to analyze and identify factors associated with incidence of MI, stroke, and death within 30 days of surgery. The utility of 2-factor mFI consisting of functional dependence and dyspnea in predicting these complications was separately tested with univariable logistic regression.

Results

Of 191 patients meeting study criteria, 2.1 % had strokes, 3.7 % MIs, and 3.7 % died. Preoperative aspirin use (OR 0.09, 95 % CI:0.01–0.8, p = .02) was associated with lower odds of stroke. Functional status (OR 14.1, 95 % CI:1.4–151.0, p = .02) and dyspnea (OR 22.6, 95 % CI:2.1–309.3, p < .01) were associated with higher odds of MI, while statin use (OR 0.07, 95 % CI:0.007–0.5, p = .01) was associated with lower odds. Death was less frequent in elective cases (OR 0.1, 95 % CI:0.005–0.6, p = .04). The 2-factor mFI was not predictive of stroke but did predict MI and death and outperformed an existing 5-factor mFI.

Conclusion

The risk profile of CEA can be acceptable in highly select nonagenarians. Functionally independent, non-dyspneic nonagenarians with preoperative aspirin and statin use who are scheduled electively have the lowest risk for a 30-day complication following CEA. Functional dependence and dyspnea are reasonable surrogate measures of frailty and may indicate a high complication risk for nonagenarians being considered for CEA.
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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