虚弱对肝内胆管癌患者肝叶切除术短期疗效的影响:2005-2018年美国全国住院患者样本的证据。

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2024-01-31 DOI:10.1159/000536401
Li Xu, Zhuo Shao, Hanchun Huang, Duo Li, Tianxiao Wang, Manar Atyah, Wenying Zhou, Zhiying Yang
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引用次数: 0

摘要

简介:本研究旨在通过具有全国代表性的大样本,评估接受肝叶切除术的 ICC 患者的虚弱程度与预后之间的关系:本研究旨在通过具有全国代表性的大型样本,评估接受肝叶切除术的 ICC 患者的虚弱程度与预后之间的关系:这项基于人群的回顾性观察研究从美国全国住院患者样本(NIS)数据库中提取了2005年至2018年期间年龄≥20岁、接受肝叶切除术的ICC成人患者的数据。虚弱程度通过有效的医院虚弱风险评分(HFRS)进行评估。采用逻辑回归分析法分析了虚弱与手术结果之间的关联:经排除后,共纳入 777 名患者,其中包括 427 名体弱患者和 350 名非体弱患者。患者的平均年龄为 64.5 (± 0.4) 岁,大多数为男性(51.1%)和白人(76.5%)。体弱与院内死亡率(aOR:18.51,95%CI:6.70,51.18)、非居家出院(aOR:3.58,95%CI:2.26,5.66)、住院时间延长(aOR:5.56,95%CI:3.87,7.99)、围手术期心脏骤停/中风(aOR:5.44,95%CI:1.62,18.24)、急性呼吸窘迫综合征(ARDS)/呼吸衰竭(aOR:3.88,95%CI:2.40,6.28)、气管切开术/通气(aOR:3.83,95%CI:2.23,6.58)、出血/输血(aOR:1.67,95%CI:1.24,2.26)、急性肾损伤(AKI)(aOR:14.37,95%CI:7.13,28.99)、术后休克(aOR:4.44,95%CI:2.54,7.74)和败血症(aOR:11.94,95%CI:6.90,20.67):讨论/结论:在接受肝叶切除术的ICC患者中,HFRS定义的虚弱程度是恶化住院预后的有力预测因素,包括院内死亡、住院时间延长、不利出院和并发症(围手术期心脏骤停/中风、ARDS/呼吸衰竭、气管切开/通气、出血/输血、AKI、术后休克和脓毒症)。研究结果有助于对接受ICC肝切除术的体弱患者进行风险分层。
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Impact of Frailty on Short-Term Outcomes of Hepatic Lobectomy in Patients with Intrahepatic Cholangiocarcinoma: Evidence from the US Nationwide Inpatient Sample 2005-2018.

Introduction: This study aimed to evaluate associations between frailty and outcomes in patients with intrahepatic cholangiocarcinoma (ICC) undergoing hepatic lobectomy using a large, nationally representative sample.

Methods: This population-based, retrospective observational study extracted the data of adults ≥20 years old with ICC undergoing hepatic lobectomy from the US Nationwide Inpatient Sample database between 2005 and 2018. Frailty was assessed by the validated Hospital Frailty Risk Score (HFRS). Associations between frailty and surgical outcomes were analyzed using logistic regression analyses.

Results: After exclusions, 777 patients were enrolled, including 427 frail and 350 non-frail. Patients' mean age was 64.5 (±0.4) years and the majority were males (51.1%) and whites (76.5%). Frailty was significantly associated with increased odds of in-hospital mortality (aOR: 18.51, 95% CI: 6.70, 51.18), non-home discharge (aOR: 3.58, 95% CI: 2.26, 5.66), prolonged LOS (aOR: 5.56, 95% CI: 3.87, 7.99), perioperative cardiac arrest/stroke (aOR: 5.44, 95% CI: 1.62, 18.24), acute respiratory distress syndrome (ARDS)/respiratory failure (aOR: 3.88, 95% CI: 2.40, 6.28), tracheostomy/ventilation (aOR: 3.83, 95% CI: 2.23, 6.58), bleeding/transfusion (aOR: 1.67, 95% CI: 1.24, 2.26), acute kidney injury (AKI) (aOR: 14.37, 95% CI: 7.13, 28.99), postoperative shock (aOR: 4.44, 95% CI: 2.54, 7.74), and sepsis (aOR: 11.94, 95% CI: 6.90, 20.67).

Discussion/conclusion: Among patients with ICC undergoing hepatic lobectomy, HFRS-defined frailty is a strong predictor of worse in-patient outcomes, including in-hospital death, prolonged LOS, unfavorable discharge, and complications (perioperative cardiac arrest/stroke, ARDS/respiratory failure, tracheostomy/ventilation, bleeding/transfusion, AKI, postoperative shock, and sepsis). Study results may help stratify risk in frail patients undergoing hepatic resection for ICC.

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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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