老年外科患者衰弱和认知障碍围手术期的影响：一项多中心纵向队列研究。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-09-17 DOI:10.1016/j.jclinane.2025.112015

Eric Cheuk BSc , Ellene Yan HBSc , Yasmin Alhamdah MSc , Aparna Saripella MSc , Sinead Campbell MB, BCh, BAO , David He MD, PhD , Leif Erik Lovblom PhD , Jean Wong MD , Frances Chung MD

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引用次数: 0

摘要

简介：虚弱和认知障碍（CI）是老年患者普遍存在的状况，往往并存，并导致较差的围手术期预后。尽管如此，术前并没有常规评估这些情况，而且它们在围手术期的影响和相互作用仍然知之甚少。使用超快速筛查工具，本研究旨在(1)比较有和没有CI的患者围手术期虚弱的患病率和发展轨迹；(2)调查患者报告的结果测量和临床结果与术前虚弱和CI相关。方法：本多中心纵向队列研究使用超快速筛查工具评估370例老年非心脏手术患者的CI和虚弱程度：确定痴呆八项问卷（AD8）（截止值：≥2）和虚弱五项问卷（虚弱前期：1-2；虚弱：≥3）。使用线性混合效应模型分析CI患者与非CI患者的衰弱轨迹。进行单变量和多变量logistic回归，以确定与术前虚弱相关的危险因素。主要结果：高达63%的老年手术患者出现术前不适（48%）或虚弱（15%）。81%的术前CI患者术前虚弱（49%）或虚弱（32%）。术后各时间点CI患者比未CI患者更虚弱。术前被分类为体弱/体弱的患者比健壮的患者住院时间更长，非家庭出院的发生率更高，30天的综合结果也更高。合并易感/虚弱和CI的患者的90天综合预后明显差于单独易感/虚弱的患者。在多变量分析中，女性（3倍）、骨科手术（7倍）、严重的术前功能障碍（6倍）和阻塞性睡眠呼吸暂停的高风险（5倍）与术前虚弱显著相关。结论：术前CI患者在围手术期各时间点均明显较未行CI患者虚弱。虽然术前不舒服/虚弱与30天预后显著恶化相关，但只有不舒服/虚弱和CI合并的患者在90天的长期预后较差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

The perioperative impact of frailty and cognitive impairment in older surgical patients: A multicentered longitudinal cohort study

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The perioperative impact of frailty and cognitive impairment in older surgical patients: A multicentered longitudinal cohort study

Introduction

Frailty and cognitive impairment (CI) are prevalent conditions that often co-exist in older patients and lead to worse perioperative outcomes. Despite this, these conditions are not routinely assessed preoperatively, and their impact and interactions during the perioperative period remain poorly understood. Using ultra-rapid screening tools, this study aimed to (1) compare the perioperative prevalence and trajectory of frailty between patients with and without CI and (2) investigate patient-reported outcome measures and clinical outcomes associated with preoperative frailty and CI.

Methods

This multicentered longitudinal cohort study assessed CI and frailty in 370 older non-cardiac surgical patients using ultra-rapid screening tools: the Ascertain Dementia Eight-item Questionnaire (AD8) (cutoff: ≥2) and 5-item FRAIL Questionnaire (prefrail: 1–2; frail: ≥3). The trajectories of frailty in CI versus no-CI patients were analyzed using a linear mixed-effects model. Univariable and multivariable logistic regressions were conducted to identify risk factors associated with preoperative frailty.

Main results

Up to 63% of older surgical patients experienced preoperative prefrailty (48%) or frailty (15%). Eighty-one percent of patients with preoperative CI were preoperatively prefrail (49%) or frail (32%). Patients with CI were more frail at all postoperative time points than no-CI patients. Patients classified as prefrail/frail preoperatively had longer length of stay, greater incidence of non-home discharge, and composite outcomes at 30 days than robust patients. Patients with combined prefrailty/frailty and CI experienced significantly worse 90-day composite outcomes than those with prefrailty/frailty alone. In the multivariable analysis, females (3-fold), orthopedic surgery (7-fold), significant preoperative functional disability (6-fold), and high risk of obstructive sleep apnea (5-fold) were significantly associated with preoperative frailty.

Conclusions

Patients with preoperative CI were significantly more frail at all perioperative time points than those without. While preoperative prefrailty/frailty was associated with significantly worse 30-day outcomes, only patients with combined prefrailty/frailty and CI experienced worse long-term outcomes at 90 days.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.