背景:虚弱与术后死亡率和发病率增加有关;然而,使用改良衰弱指数(mFI-11)评估接受憩室疾病手术的患者尚未得到广泛评估.本文旨在研究脆弱,通过mFI-11进行评估,以评估接受结肠憩室疾病手术干预的患者的术后发病率和死亡率。
方法:我们使用了来自医疗保健成本和利用项目国家住院患者样本(2015年10月1日至2019年12月31日)的数据。ICD-10-CM代码用于识别一组主要入院诊断为憩室炎的成年患者。mFI-11项目适用于ICD-10-CM代码。患者分为稳健组(mFI<0.27)和脆弱组(mFI≥0.27)。主要结果是院内术后发病率和死亡率。次要结果包括系统特异性术后并发症,停留时间(LOS)总入场费,和放电处理。拟合多元回归模型。
结果:在26,826名患者中,有24,194例mFI-11<0.27的患者(即,健壮)和2,632例mFI-11≥0.27的患者(即脆弱)。调整后的分析显示,术后死亡率(aOR2.16,95%CI1.38-3.38,p=0.001)和术后总发病率(aOR1.84,95%CI1.65-2.06,p<0.001)显着增加。虚弱组的LOS较高(MD1.78天,95%CI1.46-2.11,p<0.001)以及总成本(MD$25,495.19,95%CI$19,851.63-$31,138.75,p<0.001)。
结论:在选修设置中,高mFI-11(即,包含指标的变量的存在)可以提醒临床医生实施术前优化策略的可能性。在紧急情况下,高mFI-11可能有助于指导这些脆弱患者的预后.
BACKGROUND: Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease.
METHODS: We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit.
RESULTS: Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38-3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65-2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46-2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001).
CONCLUSIONS: In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients.