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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery
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The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery

机译：脆弱对Sinonasal癌手术围手术期结果和资源利用的影响

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Objectives/Hypothesis Frailty is a measure of decreased physiologic reserve that has been associated with adverse outcomes in older surgical patients. We aimed to measure the association of preoperative frailty with outcomes in patients undergoing sinonasal cancer surgery. Study Design Retrospective cohort study. Methods We identified 5,346 patients in the Nationwide Readmissions Database undergoing sinonasal cancer surgery from 2010 to 2014. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty‐defining diagnoses indicator. Multivariate regression was used to analyze the association of frailty with postoperative outcomes. Results Frailty was present in 7.4% of patients. Frailty was a significant independent predictor of intensive care unit–level complications (odds ratio [OR]: 4.83; 95% confidence interval [CI]: 2.95‐7.93; P .001) and nonhome discharge (OR: 3.07; 95% CI: 1.68‐5.60; P .001). Compared to nonfrail patients, frail patients had threefold longer median length of stay (12 days vs. 4 days; P .001) and more than twofold higher median hospital costs ($44,408 vs. $18,660; P .001). Frailty outperformed advanced comorbidity (defined as Charlson‐Deyo score ≥3), age ≥80 years, and markers of surgical complexity (e.g., skull base/orbit involvement, flap reconstruction, neck dissection) in predicting serious complications, nonhome discharge, length of stay, and hospital costs. Conclusions Frailty appears to have a stronger and more consistent association with adverse outcomes and increased resource utilization after sinonasal cancer surgery than age or comorbidity index. This information may be used in surgical risk stratification and can guide strategies to prevent or mitigate adverse events in this high‐risk group. Level of Evidence NA Laryngoscope , 130:290–296, 2020
机译：目标/假设脆弱是一种衡量生理储备减少的衡量标准，其与较旧的手术患者的不良结果有关。我们的旨在衡量术前脆弱的术前脆弱术后患者患者患者癌症手术。研究设计回顾性队列研究。方法鉴定了2010年至2014年全国性入院数据库中的5,346名患者，从2010年到2014年进行了Sinonasal癌症手术。使用Johns Hopkins调整后的临床组定义了脆弱定义诊断指标。多元回归用于分析术后结果的脆弱协会。结果为7.4％的患者存在脆弱。脆弱是重症监护单位水平并发症的重要独立预测因素（赔率比[或]：4.83; 95％置信区间[CI]：2.95-7.93; P＆ .001）和非全球出院（或3.07; 95％ CI：1.68-5.60; p＆ .001）。与非饲养患者相比，脆弱患者的寿命长度较长了三倍（12天与4天; P＆ .001），高于24,408美元的24,408美元; P＆ .001）。脆弱优于先进的共聚合并（定义为Charlson-Deyo得分≥3），年龄≥80岁，以及手术复杂性的标记（例如，头骨基部/轨道参与，皮瓣重建，颈部解剖）预测严重并发症，非全部放电，长度住宿和医院费用。结论脆弱似乎具有更强，更符合不利结果的关联，并且在Sinonasal癌症手术后的资源利用增加而不是年龄或合并症指数。该信息可用于外科风险分层，并指导策略以预防或减轻这种高危组的不良事件。证据水平na喉镜，130：290-296,2020

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