虚弱,生理储备减少的状态,已被证明对手术结果有显著影响。作者试图研究虚弱对接受经蝶入路垂体手术患者短期预后的影响。
研究了来自2000-2014年全国(全国)住院患者样本的加权数据。确定了诊断为垂体瘤或接受过经蝶窦垂体手术的疾病的患者。使用约翰霍普金斯调整临床组(ACG)虚弱定义诊断指标确定虚弱。使用标准描述性技术和匹配的倾向评分分析来探索术后并发症的比值比,放电处置,和成本。
共有115,317例病例纳入分析。1.48%的病例存在虚弱。虚弱患者与非虚弱患者的平均年龄为57.14±16.96岁(平均值±标准差)与51.91±15.88岁,分别(p<0.001)。与非虚弱患者相比,虚弱患者年龄≥65岁的比例更高(37.08%vs24.08%,分别,p<0.001)。虚弱的患者更可能是黑人或西班牙裔(p<0.001),拥有医疗保险或医疗补助保险(p<0.001),属于低收入群体(p<0.001),并且具有更大的合并症(p<0.001)。倾向评分匹配的多变量分析结果显示,体弱患者更容易发生液体和电解质紊乱(OR1.61,95%CI1.07-2.43,p=0.02),颅内血管并发症(OR2.73,95%CI1.01-7.49,p=0.04),精神状态变化(OR3.60,95%CI1.65-7.82,p<0.001),和内科并发症,包括肺功能不全(OR2.01,95%CI1.13-4.05,p=0.02)和急性肾衰竭(OR4.70,95%CI1.88-11.74,p=0.01)。体弱患者的死亡率较高(1.46%vs0.37%,p<0.001)。虚弱的患者也表现出非常规出院的可能性更大(p<0.001),较高的平均总费用($109,614.33[95%CI$92,756.09-$126,472.50]与$56,370.35[95%CI$55,595.72-$57,144.98],p<0.001),住院时间更长(9.27天[95%CI7.79-10.75]vs4.46天[95%CI4.39-4.53],p<0.001)。
经蝶入路垂体手术患者的虚弱与更差的术后预后和更高的费用有关。表明状态在常规术前风险分层中的潜在作用。
Frailty, a state of decreased physiological reserve, has been shown to significantly impact outcomes of surgery. The authors sought to examine the impact of frailty on the short-term outcomes of patients undergoing transsphenoidal pituitary surgery.
Weighted data from the 2000-2014 National (Nationwide) Inpatient Sample were studied. Patients diagnosed with pituitary tumors or disorders who had undergone transsphenoidal pituitary surgery were identified. Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. Standard descriptive techniques and matched propensity score analyses were used to explore the odds ratios of postoperative complications, discharge dispositions, and costs.
A total of 115,317 cases were included in the analysis. Frailty was present in 1.48% of cases. The mean age of frail versus non-frail patients was 57.14 ± 16.96 years (mean ± standard deviation) versus 51.91 ± 15.88 years, respectively (p < 0.001). A greater proportion of frail compared to non-frail patients had an age ≥ 65 years (37.08% vs 24.08%, respectively, p < 0.001). Frail patients were more likely to be black or Hispanic (p < 0.001), possess Medicare or Medicaid insurance (p < 0.001), belong to lower-median-income groups (p < 0.001), and have greater comorbidity (p < 0.001). Results of propensity score-matched multivariate analysis revealed that frail patients were more likely to develop fluid and electrolyte disorders (OR 1.61, 95% CI 1.07-2.43, p = 0.02), intracranial vascular complications (OR 2.73, 95% CI 1.01-7.49, p = 0.04), mental status changes (OR 3.60, 95% CI 1.65-7.82, p < 0.001), and medical complications including pulmonary insufficiency (OR 2.01, 95% CI 1.13-4.05, p = 0.02) and acute kidney failure (OR 4.70, 95% CI 1.88-11.74, p = 0.01). The mortality rate was higher among frail patients (1.46% vs 0.37%, p < 0.001). Frail patients also demonstrated a greater likelihood for nonroutine discharges (p < 0.001), higher mean total charges ($109,614.33 [95% CI $92,756.09-$126,472.50] vs $56,370.35 [95% CI $55,595.72-$57,144.98], p < 0.001), and longer hospitalizations (9.27 days [95% CI 7.79-10.75] vs 4.46 days [95% CI 4.39-4.53], p < 0.001).
Frailty in patients undergoing transsphenoidal pituitary surgery is associated with worse postoperative outcomes and higher costs, indicating that state\'s potential role in routine preoperative risk stratification.