虚弱对术后独立生活的影响:基于人群的回顾性队列研究

IF 3.3 Q2 GERIATRICS & GERONTOLOGY
A Garland, T Mutter, O Ekuma, C Papadimitropolous
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引用次数: 0

摘要

背景:大多数人重视生活质量,而不是单纯的时间长短。至少有 50%的人极不愿意住进养老院(NH):评估术前体弱是否与术后新的养老院安置有关:2000-2017年在加拿大马尼托巴省进行的基于人口的回顾性队列研究:7408名年龄≥65岁的患者接受了16种不同手术压力(OSS)的特定择期非心脏手术中的任何一种:主要结果是指数医院幸存者在指数医院入院后 180 天内再次入住 NH 或被列入 NH 等候名单。根据管理数据,用术前虚弱指数(pFI)对虚弱程度进行评估,该指数范围为 0-1。其他结果包括 30 天和 90-180 天死亡率,以及住院后 180 天的医疗资源使用情况。分析采用多变量回归模型,并对年龄、性别、OSS、手术年份、麻醉技术和社会经济状况进行了调整。对六项结果的P值进行了调整:受试者的平均年龄(±SD)为 74±7 岁;61% 为男性。PFI 为 0-0.68,平均值(±SD)为 0.21±0.09。所有六种结果都与体弱程度明显相关。pFI 每增加 0.1 个单位,新入住 NH 或等待入院的危险比为 3.01(p 结论:虽然我们的研究与之前的研究结果一致,都表明体弱程度越高,术后出院到 NH 的概率就越高,但我们的研究克服了之前所有研究的一些局限性。因此,我们有充分的理由认为,应该对潜在的手术候选者进行体弱程度评估,并在他们的知情同意书中讨论在失去独立性的情况下生存的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Effect of Frailty on Independent Living After Surgery: A Population-Based Retrospective Cohort Study.

Background: Most people value quality of life over mere duration. At least 50% of people are extremely averse to ever living in a nursing home (NH).

Objectives: Assess whether pre-operative frailty is associated with new, post-operative NH placement.

Design, setting: Retrospective, population-based cohort study in the Canadian province of Manitoba, 2000-2017.

Participants: 7408 persons ≥65 years undergoing any of 16 specific, elective, noncardiac surgeries of varying Operative Surgical Stress (OSS).

Measurements: The primary outcome was new admission to a NH, or being placed on a waiting list for a NH, within 180 days of index hospital admission, among index hospital survivors. Frailty was assessed from administrative data by the Preoperative Frailty Index (pFI), which ranges 0-1. Other outcomes were 30-day and 90-180 day mortality, and post-hospital medical resource use to 180 days. Analyses used multivariable regression models, adjusted for age, sex, OSS, year of surgery, anesthetic technique, and socioeconomic status. P-values were adjusted for the six outcomes.

Results: Subjects had mean age (±SD) of 74±7 yrs; 61% were male. pFI ranged 0-0.68, with a mean±SD of 0.21±0.09. All six outcomes were significantly associated with greater frailty. Each additional 0.1 unit increase in pFI was associated with a hazard ratio for new NH admission or wait-listing of 3.01 (p<0.0006).

Conclusions: While our study agrees with prior work indicating that greater frailty is associated with higher probability of post-operative discharge to a NH, it overcomes a number of limitations of all prior work. Strong arguments follow that prospective surgical candidates be evaluated for their degree of frailty, and that their informed consent include discussion of the possibility of survival with loss of independence.

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来源期刊
Journal of Frailty & Aging
Journal of Frailty & Aging GERIATRICS & GERONTOLOGY-
CiteScore
5.90
自引率
7.70%
发文量
54
期刊介绍: The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons.          The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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