Abstract：
BACKGROUND: Frailty is a clinically identifiable condition characterized by heightened vulnerability. The 5-item Modified Frailty Index provides a concise calculation of frailty that has proven effective in predicting adverse perioperative outcomes across a variety of surgical disciplines. However, there is a paucity of research examining the validity of 11-item Modified Frailty Index (mFI-5) in carotid endarterectomy (CEA). This study aimed to investigate the association between mFI-5 and 30-day outcomes of CEA.
METHODS: Patients underwent CEA were identified from American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012 to 2021. Patients with age<18 were excluded. Patients were stratified into four cohorts based on their mFI-5 scores: 0, 1, 2, or 3+. Multivariable logistic regression was used to compare 30-day perioperative outcomes adjusting for preoperative variables with P value<0.1.
RESULTS: Compared to controls (mFI-5 = 0), patients mFI-5 = 1 had higher risk of stroke (adjusted odds ratio [aOR] = 1.333, P = 0.02), unplanned operation (aOR = 1.38, P < 0.01), and length of stay (LOS) > 7 days (aOR = 0.814, P < 0.01). Patients with mFI-5 = 2 had higher stroke (aOR = 1.719, P < 0.01), major adverse cardiovascular events (MACE) (aOR = 1.315, P = 0.01), sepsis (aOR = 2.243, P = 0.01), discharge not to home (aOR = 1.200, P < 0.01), 30-day readmission (aOR = 1.405, P < 0.01). Compared with controls, patients with mFI-5≥3 had higher mortality (aOR = 1.997 P = 0.02), MACE (aOR = 1.445, P = 0.03), cardiac complications (aOR = 1.901, P < 0.01), pulmonary events (aOR = 2.196, P < 0.01), sepsis (aOR = 3.65, P < 0.01), restenosis (aOR = 2.606, P = 0.02), unplanned operation (aOR = 1.69, P < 0.01), LOS>7 days (aOR = 1.425, P < 0.01), discharge not to home (aOR = 2.127, P < 0.01), and 30-day readmission (aOR = 2.427, P < 0.01).
CONCLUSIONS: The mFI-5 is associated with 30-day mortality and complications including stroke, MACE, cardiac complications, pulmonary complications, sepsis, and restenosis. Additionally, elevated mFI-5 scores correlate with an increased likelihood of unplanned operations, extended LOS, discharge to facilities other than home, and 30-day readmissions, all of which could negatively impact long-term prognosis. Therefore, mFI-5 can serve as a concise yet effective metric of frailty in patients undergoing CEA.
METHODS: Patients underwent CEA were identified from American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012 to 2021. Patients with age<18 were excluded. Patients were stratified into four cohorts based on their mFI-5 scores: 0, 1, 2, or 3+. Multivariable logistic regression was used to compare 30-day perioperative outcomes adjusting for preoperative variables with P value<0.1.
RESULTS: Compared to controls (mFI-5 = 0), patients mFI-5 = 1 had higher risk of stroke (adjusted odds ratio [aOR] = 1.333, P = 0.02), unplanned operation (aOR = 1.38, P < 0.01), and length of stay (LOS) > 7 days (aOR = 0.814, P < 0.01). Patients with mFI-5 = 2 had higher stroke (aOR = 1.719, P < 0.01), major adverse cardiovascular events (MACE) (aOR = 1.315, P = 0.01), sepsis (aOR = 2.243, P = 0.01), discharge not to home (aOR = 1.200, P < 0.01), 30-day readmission (aOR = 1.405, P < 0.01). Compared with controls, patients with mFI-5≥3 had higher mortality (aOR = 1.997 P = 0.02), MACE (aOR = 1.445, P = 0.03), cardiac complications (aOR = 1.901, P < 0.01), pulmonary events (aOR = 2.196, P < 0.01), sepsis (aOR = 3.65, P < 0.01), restenosis (aOR = 2.606, P = 0.02), unplanned operation (aOR = 1.69, P < 0.01), LOS>7 days (aOR = 1.425, P < 0.01), discharge not to home (aOR = 2.127, P < 0.01), and 30-day readmission (aOR = 2.427, P < 0.01).
CONCLUSIONS: The mFI-5 is associated with 30-day mortality and complications including stroke, MACE, cardiac complications, pulmonary complications, sepsis, and restenosis. Additionally, elevated mFI-5 scores correlate with an increased likelihood of unplanned operations, extended LOS, discharge to facilities other than home, and 30-day readmissions, all of which could negatively impact long-term prognosis. Therefore, mFI-5 can serve as a concise yet effective metric of frailty in patients undergoing CEA.
摘要：
背景：脆弱是一种临床上可识别的疾病，其特征是易损性增强。5项改良的脆弱指数提供了一个简明的脆弱计算，已被证明可有效预测各种外科学科的不良围手术期结局。然而,对11项改良衰弱指数(mFI-5)在颈动脉内膜切除术(CEA)中的有效性进行检验的研究很少.本研究旨在探讨mFI-5与CEA30天结局之间的关系。
方法：接受CEA的患者来自2012年至2021年美国外科医师学会国家外科质量改善计划目标数据库。年龄<18岁的患者被排除在外。根据mFI-5评分将患者分为4组：0、1、2或3+。采用多变量logistic回归比较30天的围手术期结局，调整P值<0.1的术前变量。
结果：与对照组（mFI-5=0）相比，mFI-5=1的患者卒中风险较高(校正比值比[aOR]=1.333,P=0.02),计划外操作(AOR=1.38,P<0.01),住院时间(LOS)>7天(aOR=0.814,P<0.01)。mFI-5=2的患者卒中发生率较高(aOR=1.719,P<0.01),主要不良心血管事件(MACE)(AOR=1.315,P=0.01),脓毒症(aOR=2.243,P=0.01),出院不在家(aOR=1.200，P<0.01)，再入院30天(aOR=1.405,P<0.01)。与对照组相比，mFI-5≥3的患者死亡率较高(aOR=1.997P=0.02),MACE（aOR=1.445，P=0.03），心脏并发症(aOR=1.901,P<0.01),肺事件（aOR=2.196，P<0.01），脓毒症(aOR=3.65,P<0.01),再狭窄(aOR=2.606,P=0.02),计划外操作(AOR=1.69,P<0.01),LOS>7天(aOR=1.425,P<0.01),出院不在家(aOR=2.127，P<0.01)，再入院30天(aOR=2.427,P<0.01)。
结论：mFI-5与30天死亡率和包括卒中在内的并发症相关，MACE,心脏并发症,肺部并发症,脓毒症,再狭窄.此外,mFI-5分数升高与计划外操作的可能性增加相关，扩展LOS，排放到家庭以外的设施，和30天的再入院，所有这些都可能对长期预后产生负面影响.因此,mFI-5可以作为CEA患者虚弱的简明而有效的指标。
方法：接受CEA的患者来自2012年至2021年美国外科医师学会国家外科质量改善计划目标数据库。年龄<18岁的患者被排除在外。根据mFI-5评分将患者分为4组：0、1、2或3+。采用多变量logistic回归比较30天的围手术期结局，调整P值<0.1的术前变量。
结果：与对照组（mFI-5=0）相比，mFI-5=1的患者卒中风险较高(校正比值比[aOR]=1.333,P=0.02),计划外操作(AOR=1.38,P<0.01),住院时间(LOS)>7天(aOR=0.814,P<0.01)。mFI-5=2的患者卒中发生率较高(aOR=1.719,P<0.01),主要不良心血管事件(MACE)(AOR=1.315,P=0.01),脓毒症(aOR=2.243,P=0.01),出院不在家(aOR=1.200，P<0.01)，再入院30天(aOR=1.405,P<0.01)。与对照组相比，mFI-5≥3的患者死亡率较高(aOR=1.997P=0.02),MACE（aOR=1.445，P=0.03），心脏并发症(aOR=1.901,P<0.01),肺事件（aOR=2.196，P<0.01），脓毒症(aOR=3.65,P<0.01),再狭窄(aOR=2.606,P=0.02),计划外操作(AOR=1.69,P<0.01),LOS>7天(aOR=1.425,P<0.01),出院不在家(aOR=2.127，P<0.01)，再入院30天(aOR=2.427,P<0.01)。
结论：mFI-5与30天死亡率和包括卒中在内的并发症相关，MACE,心脏并发症,肺部并发症,脓毒症,再狭窄.此外,mFI-5分数升高与计划外操作的可能性增加相关，扩展LOS，排放到家庭以外的设施，和30天的再入院，所有这些都可能对长期预后产生负面影响.因此,mFI-5可以作为CEA患者虚弱的简明而有效的指标。
