METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent partial or total gastrectomy for gastric cancer between 2011 and 2021. The mFI-5 score was calculated based on the presence of hypertension, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and partially or fully dependent functional status. Patients were stratified into 3 groups according to mFI-5 score (mFI-5 = 0, mFI-5 = 1, mFI-5 ≥ 2). Univariate analysis and multivariate logistic regression were used to evaluate the association between mFI-5 score and post-operative outcomes.
RESULTS: 7438 patients were identified (mFI-5 = 0: 3032, mFI-5 = 1: 2805, mFI-5 ≥ 2: 1601). mFI-5 ≥ 2 was an independent predictor of overall complications (OR 1.43, p < 0.001), serious complications (OR 1.42, p < 0.001), pneumonia (OR 1.43, p = 0.010), MI (OR 2.91, p = 0.005), and readmission within 30 days (OR 1.33, p = 0.008). Patients with higher frailty were more likely to experience unplanned intubation (OR 2.06, p < 0.001; OR 2.47, p < 0.001), failure to wean from the ventilator (OR 1.68, p = 0.003; OR 2.00, p < 0.001), acute renal failure (OR 3.25, p = 0.003; OR 3.27, p = 0.005), 30-day mortality (OR 1.73, p = 0.009; OR 1.94, p = 0.004), and non-home discharge (OR 1.34, p = 0.001; OR 1.74, p < 0.001) relative to non-frail patients.
CONCLUSIONS: Higher frailty, as indicated by an increased mFI-5 score, raises the risk of serious post-operative complications in patients with gastric cancer undergoing gastrectomy. The mFI-5 has the potential to help identify high-risk patients and enhance pre-operative discussions and optimization.
方法:国家外科质量改进计划(NSQIP)数据库查询了2011年至2021年期间接受部分或全胃切除术治疗胃癌的患者。根据高血压的存在计算mFI-5评分,充血性心力衰竭,糖尿病,慢性阻塞性肺疾病,以及部分或完全依赖的功能状态。根据mFI-5评分将患者分为3组(mFI-5=0,mFI-5=1,mFI-5≥2)。采用单因素分析和多因素logistic回归分析mFI-5评分与术后结局的相关性。
结果:7438例患者(mFI-5=0:3032,mFI-5=1:2805,mFI-5≥2:1601)。mFI-5≥2是总并发症的独立预测因子(OR1.43,p<0.001),严重并发症(OR1.42,p<0.001),肺炎(OR1.43,p=0.010),MI(OR2.91,p=0.005),30天内再入院(OR1.33,p=0.008)。虚弱程度较高的患者更有可能经历非计划插管(OR2.06,p<0.001;OR2.47,p<0.001),未能从呼吸机上断奶(OR1.68,p=0.003;OR2.00,p<0.001),急性肾功能衰竭(OR3.25,p=0.003;OR3.27,p=0.005),30天死亡率(OR1.73,p=0.009;OR1.94,p=0.004),和非家庭出院(OR1.34,p=0.001;OR1.74,p<0.001)相对于非虚弱患者。
结论:更脆弱,如mFI-5分数增加所示,增加了胃癌患者术后严重并发症的风险。mFI-5有可能帮助识别高风险患者,并加强术前讨论和优化。