FRailty in Australian patients admitted to Intensive care unit after eLective CANCER-related SURGery: a retrospective multicentre cohort study (FRAIL-CANCER-SURG study)

被引：2

作者：

Ling, Ryan R. ^{[1
,2
]}

Ueno, Ryo ^{[2
,3
]}

Alamgeer, Muhammad ^{[4
,5
,6
]}

Sundararajan, Krishnaswamy ^{[7
,8
]}

Sundar, Raghav ^{[1
,9
,10
,11
,12
]}

Bailey, Michael ^{[3
]}

Pilcher, David ^{[3
,13
,14
]}

Subramaniam, Ashwin ^{[3
,15
,16
,17
]}

机构：

[1] Natl Univ Singapore, Natl Univ Hlth Syst, Yong Loo Lin Sch Med, Singapore, Singapore

[2] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia

[3] Eastern Hlth, Box Hill Hosp, Dept Intens Care, Box Hill, Vic, Australia

[4] Monash Univ, Sch Clin Sci, Dept Med, Clayton, Vic, Australia

[5] Monash Hlth, Dept Med Oncol, Clayton, Vic, Australia

[6] Monash Univ, Ctr Canc Res, Hudson Inst Med Res, Clayton, Vic, Australia

[7] Royal Adelaide Hosp, Dept Intens Care, Adelaide, SA, Australia

[8] Univ Adelaide, Adelaide Med Sch, Adelaide, SA, Australia

[9] Natl Univ Singapore Hosp, Natl Univ Canc Inst, Dept Haematol Oncol, Singapore, Singapore

[10] Duke NUS Med Sch, Canc & Stem Cell Biol Program, Singapore 165897, Singapore

[11] Natl Univ Singapore, 1 Inst Hlth, Singapore, Singapore

[12] Singapore Gastr Canc Consortium, Singapore, Singapore

[13] Australian & New Zealand Intens Care Soc, Ctr Outcome & Resource Evaluat, Melbourne, Vic, Australia

[14] Alfred Hosp, Dept Intens Care, Melbourne, Vic, Australia

[15] Peninsula Hlth, Dept Intens Care, Frankston, Vic, Australia

[16] Dandenong Hosp, Dept Intens Care, Dandenong, Vic, Australia

[17] Monash Univ, Peninsula Clin Sch, Frankston, Vic, Australia

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2024年 / 132卷 / 04期

关键词：

cancer surgery; clinical frailty scale; elective cancer surgery; frailty; long-term survival; solid tumour; ANZROD MODEL; OUTCOMES; ADMISSION; TRENDS;

D O I：

10.1016/j.bja.2024.01.020

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: The association between frailty and short-term and long-term outcomes in patients receiving elective surgery for cancer remains unclear, particularly in those admitted to the ICU. Methods: In this multicentre retrospective cohort study, we included adults >= 16 yr old admitted to 158 ICUs in Australia from January 1, 2018 to March 31, 2022 after elective surgery for cancer. We investigated the association between frailty and survival time up to 4 yr (primary outcome), adjusting for a prespecified set of covariates. We analysed how this association changed in specific subgroups (age categories [ < 65, 65 - 80, >= 80 yr], and those who survived hospitalisation), and over time by splitting the survival information at monthly intervals. Results: We included 35,848 patients (median follow-up: 18.1 months [inter -quartile range: 8.3 - 31.1 months], 19,979 [56.1%] male, median age 69.0 yr [inter -quartile range: 58.8 - 76.0 yr]). Some 3502 (9.8%) patients were frail (defined as clinical frailty scale >= 5). Frailty was associated with lower survival (hazard ratio: 1.72, 95% confidence interval [CI]: 1.59 - 1.86 compared with clinical frailty scale < 4); this was concordant across several sensitivity analyses. Frailty was most strongly associated with mortality early on in follow-up, up to 10 months (hazard ratio: 1.39, 95% CI: 1.03 - 1.86), but this association plateaued, and its predictive capacity subsequently diminished with time up until 4 yr (1.96, 95% CI: 0.73 - 5.28). Frailty was associated with similar effects when stratified based on age, and in those who survived hospitalisation. Conclusions: Frailty was associated with poorer outcomes after an ICU admission after elective surgery for cancer, particularly in the short term. However, its predictive capacity with time diminished, suggesting a potential need for longitudinal reassessment to ensure appropriate prognostication in this population.

引用

页码：695 / 706

页数：12

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