老龄患者术后死亡或残疾的预测

本文由“小麻哥的日常”授权转载

摘要译文（供参考）  

老龄患者术后死亡或残疾的预测

背景：

老年患者在手术后很容易出现新的或恶化的残疾。尽管如此，导致术后残疾的患者或手术特征尚不明确。我们的目的是开发和验证一个模型，随后转换为积分形式，以预测老年患者手术后6个月的死亡或残疾。  

方法：  

作者建立了一个前瞻性的单中心注册中心来开发和验证预测模型。该登记包括2017年5月25日至2021年2月11日期间接受选择性和非选择性心脏和非心脏手术的70岁或以上患者，以及直接从患者那里收集的电子病历、医院管理数据（ICD-10 AM代码）和世界卫生组织残疾评估表（WHODAS）数据的综合临床数据。死亡或残疾被定义为死亡或WHODAS评分≥16%。纳入的患者被随机分为模型开发（70%）和内部验证（30%）队列。构建后，使用内部验证队列和外部验证队列（包括来自单独随机试验的数据）对逻辑回归和得分模型进行评估。  

结果：  

在2176名在手术前立即完成WHODAS的患者中，927名（43%）患者患有残疾，413名（19%）患者患有严重残疾。到手术后6个月，1640名患者（75%）拥有可用于主要结果分析的数据。在这些患者中，195名（12%）患者死亡，691名（42%）患者死亡或致残。建立的评分模型包括术前WHODAS评分、患者年龄、痴呆和慢性肾脏疾病。得分模型在内部（曲线下面积0.74，95%CI ：0.69~0.79）和外部（曲线下区域0.77，95%CI ：0.74~0.80）验证数据集中保持了良好的区分。  

结论：  

我们开发并验证了一个分数模型来预测老年患者手术后的死亡或残疾。  

原文摘要

Predicting Death or Disability after Surgery in the Older Adult Background: Older patients are vulnerable to developing new or worsening disability after surgery. Despite this, patient or surgical characteristics predisposing to postoperative disability are poorly defined. Our aim was to develop and validate a model, subsequently transformed to point-score form, to predict 6-month death or disability in older patients after surgery. 

Methods: The authors built a prospective, single-center registry to develop and validate the prediction model. The registry included patients 70 years of age or older undergoing elective and non-elective, cardiac and non-cardiac surgery between 25 May 2017 to 11 February 2021, and combined clinical data from the electronic medical record, hospital administrative data (ICD-10 AM codes) and World Health Organization Disability Assessment Schedule (WHODAS) data collected directly from the patients. Death or disability was defined as being dead or having a WHODAS score ≥16%. Included patients were randomly divided into model development (70%) and internal validation (30%) cohorts. Once constructed, the logistic regression and point-score models were assessed using the internal validation cohort and an external validation cohort comprising data from a separate randomized trial. 

Results: Of 2176 patients who completed the WHODAS immediately prior to surgery, 927 (43%) patients were disabled and 413 (19%) had significant disability. By 6 months after surgery, 1640 patients (75%) had data available for the primary outcome analysis. Of these patients 195 (12%) patients had died and 691 (42%) were dead or disabled.The developed point-score model included the preoperative WHODAS score, patient age, dementia, and chronic kidney disease. The point score model retained good discrimination in the internal (area under the curve 0.74, 95% CI 0.69 to 0.79) and external (area under the curve 0.77, 95% CI 0.74, 0.80) validation data sets. 

Conclusions: We developed and validated a point score model to predict death or disability in older patients after surgery.   

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱  

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