背景:显著的发病率和死亡率是体弱患者出现功能下降的标志。改良的衰弱指数5(mFI-5)表示已被验证为手术中基于共病的量表的风险预测评分。血清白蛋白水平<3.5g/dL(低蛋白血症)也与术后不良预后有关。然而,这两个参数之间的关联还有待研究.我们旨在阐明术前白蛋白水平和虚弱的相互依存关系,根据mFI-5评分评估,及其预测游离皮瓣重建(FFR)术后结果的可靠性。
方法:我们进行了多中心,回顾性队列研究,并在2008年至2021年期间访问了ACS国家手术质量改进计划(ACS-NSQIP)。我们确定了所有接受FFR的成年患者(≥18岁)。我们提取了围手术期数据和实验室值,包括白蛋白。进行多变量线性和逻辑回归分析以确定独立的风险预测因子。主要结果涉及死亡率,住院时间,再操作,医疗和外科并发症,以及术后30天内的出院目的地。
结果:共有34,571名患者被纳入研究,平均年龄为53.9岁(标准差[SD]12.2),平均体重指数(BMI)为28.8(SD6.1)。在这些病人中,男性7484人(21.6%),而22,363(64.7%)无虚弱(mFI=0)。此外,9466例患者的虚弱评分为1分(27.4%),2505得分为2(7.2%),226得分为3分(0.7%),11分4分或更高(0.0%)。16,250名患者(47.0%)可获得白蛋白水平,其中,1334(8.2%)患有低蛋白血症。回归分析显示,较高的mFI评分是任何,外科,和医疗并发症,以及增加的再操作率,计划外再入院,和延长住院时间。低白蛋白血症独立预测任何,外科,和医疗并发症,和更高的死亡率,再操作,住院时间更长。当同时考虑虚弱和白蛋白水平(mFI-5和白蛋白)时,这种综合评估被发现是所有主要结果的更准确预测指标(任何,医疗和外科并发症,死亡率,和重新操作)。Further,我们的分析发现,血清白蛋白水平与mFI评分之间存在弱负相关(SpearmanR:-.1;p<.0001).
结论:结论:这项队列研究强调了低白蛋白血症与术后不良结局的关系,包括那些与脆弱没有直接关系的。同时,mFI评分较高可独立预测与低白蛋白血症无关的结局.从这些发现开始,我们建议在接受FFR的患者中同时考虑血清白蛋白水平和虚弱.这种围手术期算法可能有助于提供更多的个性化计划,包括多学科护理和手术前后。
BACKGROUND: Significant morbidity and mortality are hallmarks of the functional decline seen in physically frail patients. The modified frailty index 5 (mFI-5) represents a risk predictor score that has been validated as a comorbidity-based scale in surgery. Serum albumin levels of <3.5 g/dL (
hypoalbuminemia) have also been implicated with poor postoperative outcomes. However, the association between these two parameters remains to be investigated. We aimed to elucidate the interdependence of preoperative albumin levels and frailty, as evaluated by the mFI-5 score, and its reliability to prognosticate postoperative results in free flap reconstruction (FFR).
METHODS: We conducted a multicenter, retrospective cohort
study and accessed the ACS National Surgical Quality Improvement Program (ACS-NSQIP) from 2008 to 2021. We identified all adult patients (≥18 years of age) who underwent a FFR. We extracted perioperative data and lab values including albumin. Multivariable linear and logistic regression analyses were performed to identify independent risk predictors. Main outcomes involved mortality, length of hospital stay, reoperation, medical and surgical complications, and discharge destination within the 30-day postoperative period.
RESULTS: A total of 34,571 patients were included in the
study, with an average age of 53.9 years (standard deviation [SD] 12.2) and an average body mass index (BMI) of 28.8 (SD 6.1). Of these patients, 7484 were male (21.6%), whereas 22,363 (64.7%) had no frailty (mFI = 0). Additionally, 9466 patients had a frailty score of 1 (27.4%), 2505 had a score of 2 (7.2%), 226 had a score of 3 (0.7%), and 11 had a score of 4 or higher (0.0%). Albumin levels were available for 16,250 patients (47.0%), and among them, 1334 (8.2%) had hypoalbuminemia. Regression analyses showed that higher mFI scores were independent predictors of any, surgical, and medical complications, as well as increased rates of reoperations, unplanned readmissions, and prolonged hospital stays.
Hypoalbuminemia independently predicted any, surgical, and medical complications, and higher mortality, reoperation, and longer hospital stay. When both frailty and albumin levels (mFI-5 and albumin) were considered together, this combined assessment was found to be a more accurate predictor of all major outcomes (any, medical and surgical complications, mortality, and reoperation). Further, our analysis identified a weak negative correlation between serum albumin levels and mFI scores (Spearman R: -.1; p < .0001).
CONCLUSIONS: In conclusion, this cohort
study highlights the association of
hypoalbuminemia with adverse postoperative outcomes, including those not directly related to frailty. Simultaneously, higher mFI scores independently predicted outcomes not associated with hypoalbuminemia. Stemming from these findings, we recommend considering both serum albumin levels and frailty in patients receiving FFR. This perioperative algorithm may help provide more individualized planning including multidisciplinary care and pre and posthabilitation.