目的:虚弱是指生理储备减少和功能下降的状态。我们试图分析脆弱是否,使用5项修正脆弱指数(5mFI)进行评估,与大粘膜头颈部手术后发病率和死亡率增加相关。
方法:我们对接受大粘膜头颈部手术切除2年的患者进行了回顾性研究。通过多变量回归分析控制潜在的混杂变量。
结果:包括310例患者,其中77例(24.8%)被归类为虚弱。大多数患者为男性(219/310,70.7%),有吸烟史(246/310,79.4%),手术时年龄大于65岁的患者有151例(48.7%).大多数与口腔或口咽亚部位相关的手术(227/310,73.2%)和150例患者(48.4%)进行了微血管游离组织重建。在多变量分析中,虚弱的患者更有可能遭受不良结局,如重返手术室(OR3.47,95%CI1.82-6.62,p<0.001),Clavien-DindoIV级并发症(OR6.23,95%CI2.55-15.20,p<0.001)或内科并发症,如呼吸系统并发症(OR2.61,95%CI1.45-4.69;p=0.001)或谵妄(OR5.05,95%CI2.46-10.33;p<0.001)。此外,住院时间在体弱的患者中增加(β16.46天,95%CI9.85-23.07天;p<0.001)。虚弱患者的术后90天和1年死亡率均未增加。
结论:使用5mFI评估的虚弱与更高的术后发病率相关,但不是在大粘膜头颈部手术后的死亡率。
OBJECTIVE: Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major
mucosal head and neck surgery.
METHODS: We performed a retrospective study of patients undergoing major
mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis.
RESULTS: There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82-6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55-15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45-4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46-10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85-23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients.
CONCLUSIONS: Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major
mucosal head and neck surgery.