预测老年人手术后的死亡或残疾
Mark A Shulman1, Sophie Wallace1, Annie Gilbert2
1Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia.
Anesthesiology
|July 11, 2023
概括
老年患者在手术后面临残疾风险. 一个新的点评模型预测了6个月的死亡或残疾,有助于对老年人进行手术风险评估.
科学领域:
- 老年人手术是一门老年人手术.
- 手术结果研究研究.
- 预测模型在医学中的预测模型.
背景情况:
- 老年人很容易在手术后出现新的或恶化的残疾.
- 在这个人口群体中,术后残疾的预测因素尚未得到很好的定义.
- 这项研究解决了对老年手术患者更好的风险分层的需求.
研究的目的:
- 开发和验证一个预测模型,以预测老年手术患者的6个月死亡率或残疾.
- 将模型转化为临床使用的实用分数.
- 改善手术前评估和患者咨询.
主要方法:
- 一个潜在的单中心注册表包括70岁以上的患者,他们接受了各种手术.
- 数据整合了电子健康记录,行政数据 (ICD-10-AM) 和世界卫生组织残疾评估表 (WHODAS) 的得分.
- 患者被随机分配到模型开发 (70%) 和内部验证 (30%) 队列,并使用单独的试验数据集进行外部验证.
主要成果:
- 手术前的残疾很常见,有43%的残疾人和19%的严重残疾人.
- 在6个月后,12%的患者死亡,42%的患者死亡或残疾.
- 经过验证的点评模型,包括WHODAS得分,年龄,痴呆症和慢性病,显示出良好的预测性歧视 (AUC 0.74-0.77).
结论:
- 开发并验证了一种强大的点评模型,用于预测接受手术的老年患者的死亡或残疾.
- 这种工具可以帮助临床医生识别高风险的老年患者.
- 该模型将功能状态 (WHODAS) 纳入该模型强调了它在手术风险评估中的重要性.
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