【罂粟摘要】心脏手术后虚弱与在家生存天数的关系：一项基于人群的队列研究
心脏手术后虚弱与在家生存天数的关系：一项基于人群的队列研究
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
虚弱是一种老年综合征，使人们容易受到不良后果的影响。在心脏手术中，描述虚弱和以患者为中心的不良后果之间的联系的数据很少。我们的目的是评估心脏手术后身体虚弱与在家生存天数之间的关系。
我们利用加拿大安大略省的相关卫生管理数据进行了一项基于人群的队列研究。所有年龄>65岁的心脏手术患者都接受了有效的虚弱指数评分。计算术后30天和365天的存活天数和在家天数。计算未调整和调整后的虚弱评分与在家生存天数之间的关联。
从2009年到2015年，共纳入61 389例患者。在手术后30天内(虚弱程度每增加10%，调整后均值比为0.79；95%可信区间[CI]，0.78-0.81；P<0.0001)和365d内(虚弱程度每增加10%，调整后均值比，0.92；95%可信区间，0.91-0.93；P<0.0001)，虚弱与在家生存天数减少相关。进行敏感度分析后结果一致(术后30天内在家生存减少5.0天[95%CI，4.8-5.2]，365天内减少9.0天[95%CI，8.7-9.2])。
身体虚弱与心脏大手术后在家生存的天数减少有关。这一信息应该在手术前的预后讨论中以及在对脆弱的老年患者群体的护理计划中加以考虑。在家生存的时间对于常规质量测量、报告和使用常规收集的数据进行研究可能是一个有用的结果。
McIsaac DI, et al.Br J Anaesth.2021 Jun;126(6):1103-1110. doi:10.1016/j.bja.2021.02.011.
Association of frailty with days alive at home after cardiac surgery: a population-based cohort study
Background: Frailty is a geriatric syndrome that leaves people vulnerable to adverse outcomes. In cardiac surgery,minimal data describe associations between frailty and patient-centred outcomes. Our objective was to estimate the association between frailty and days alive at home after cardiac surgery.
Methods: We conducted a population-based cohort study using linked health administrative data in the Canadian province of Ontario. All individuals >65 yr at the time of cardiac surgery were assigned a frailty score using a validated frailty index. Days alive and at home in the 30 and 365 days after surgery were calculated. The unadjusted and adjusted associations between frailty and days alive at home were calculated.
Results: We identified 61 389 patients from 2009 to 2015. Frailty was associated with reduced days at home within 30 days (adjusted ratio of means for every 10% increase in frailty=0.79; 95% confidence interval [CI], 0.78-0.81; P<0.0001) and 365 days (adjusted ratio of means for every 10% increase in frailty=0.92; 95% CI, 0.91-0.93; P<0.0001) of surgery. Results were consistent in sensitivity analyses (5.0 fewer days alive at home [95% CI, 4.8-5.2] within 30 days and 9.0 fewer days alive at home [95% CI, 8.7-9.2] within 365 days after surgery).
Conclusion: Frailty is associated with a reduction in days alive at home after major cardiac surgery. This information should be considered in prognostic discussions before surgery and in care planning for vulnerable older patient groups. Days alive at home may be a useful outcome for routine measurement in quality, reporting, and studies using routinely collected data.
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