目的:接受脊柱手术的老年患者发病率和死亡率增加。评估虚弱和术前状态对于预测术后结果至关重要。本研究旨在评估改良的脆弱指数(mFI)的预测价值,少肌症,预后营养指数(PNI)和老年营养风险指数(GNRI)在确定60岁以上斜腰椎椎间融合术(OLIF)患者术后并发症中的作用。
方法:使用11个变量评估术前危险因素,包括mFI,PNI,GNRI.比较了非虚弱患者的并发症率(mFI=0;n=50),prefrail(mFI=0.09-0.18;n=144),体弱(mFI≥0.27;n=80)患者。比较了并发症和非并发症组之间的人口统计学和围手术期变量。并发症的发生率是主要结果指标。
结果:274例患者中有36例发生并发症(13.1%)。虚弱组的肺炎发生率明显高于非虚弱组和前虚弱组。并发症组在几个变量上显示出显著差异,包括年龄,融合水平,白蛋白水平,淋巴细胞计数,血小板计数,肌酐水平,估计失血。此外,mFI,PNI,GNRI在并发症组和非并发症组之间存在显著差异。
结论:MFI,PNI,和GNRI可用于预测接受OLIF的患者的术后发病率和死亡率。这些综合评估方法可以识别高风险患者并制定量身定制的策略以增强术后结局。集成mFI,PNI,和GNRI进入术前评估过程可以帮助医疗保健提供者主动管理高风险患者,从而提高接受OLIF的老年人的整体护理质量。
OBJECTIVE: Elderly patients undergoing spinal surgery are at an increased risk of morbidity and mortality. Evaluating frailty and preoperative status is crucial for predicting postoperative outcomes. This study aimed to assess the predictive value of the modified Frailty Index (mFI), sarcopenia, Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) in determining postoperative complications in patients undergoing oblique lumbar interbody fusion (OLIF) over 60 years.
METHODS: Preoperative risk factors were assessed using 11 variables, including mFI, PNI, and GNRI. Complication rates were compared among nonfrail (mFI=0; n=50), prefrail (mFI=0.09-0.18; n=144), and frail (mFI ≥0.27; n=80) patients. Demographic and perioperative variables were compared between the complication and noncomplication groups. The incidence of complications was the primary outcome measure.
RESULTS: Complications occurred in 36 of 274 patients (13.1%). The frail group exhibited a significantly higher incidence of pneumonia than the nonfrail and prefrail groups. The complication group displayed significant differences in several variables, including age, fusion level, albumin level, lymphocyte count, platelet count, creatinine level, and estimated blood loss. Moreover, mFI, PNI, and GNRI differed significantly between the complication and noncomplication groups.
CONCLUSIONS: MFI, PNI, and GNRI can be useful for predicting postoperative morbidity and mortality in patients undergoing OLIF. These comprehensive assessment methods enable the identification of high-risk patients and the formulation of tailored strategies to enhance postoperative outcomes. Integrating mFI, PNI, and GNRI into the preoperative evaluation process can help health care providers proactively manage high-risk patients, thus improving the overall quality of care for elderly individuals undergoing OLIF.