The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

被引：28

作者：

Thillainadesan, Janani ^{[1
,2
,3
,4
]}

Mudge, Alison M. ^{[5
,6
]}

Aitken, Sarah J. ^{[2
,3
,4
,7
,8
]}

Hilmer, Sarah N. ^{[9
,10
]}

Cullen, John S. ^{[1
,2
,3
,4
]}

Yumol, Minna F. ^{[1
]}

Close, Jacqueline C. T. ^{[11
,12
]}

Norris, Christina M. ^{[11
,12
]}

Kerdic, Richard ^{[8
]}

Naganathan, Vasi ^{[1
,2
,3
,4
]}

机构：

[1] Concord Hosp, Dept Geriatr Med, Bldg 12,Hosp Rd, Concord, NSW 2139, Australia

[2] Univ Sydney, Fac Med & Hlth, Concord Clin Sch, Concord, Australia

[3] Concord Hosp, Ctr Educ & Res Ageing, Concord, Australia

[4] Concord Hosp, Ageing & Alzheimers Inst, Concord, Australia

[5] Royal Brisbane & Womens Hosp, Internal Med Res Unit, Herston, Qld, Australia

[6] Univ Queensland, Sch Clin Med, Brisbane, Qld, Australia

[7] Concord Hosp, Concord Inst Acad Surg, Vasc Surg Dept, Concord, Australia

[8] Concord Hosp, Dept Vasc Surg, Concord, Australia

[9] Univ Sydney, Sydney Med Sch, Kolling Inst Med Res, St Leonards, NSW, Australia

[10] Royal North Shore Hosp, St Leonards, NSW, Australia

[11] Neurosci Res Australia, Falls Balance & Injury Res Ctr, Randwick, NSW, Australia

[12] Prince Wales Hosp, Dept Aged Care, Randwick, NSW, Australia

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2021年 / 69卷 / 03期

基金：

英国医学研究理事会;

关键词：

frailty; geriatric surgery; delirium; function; POSTOPERATIVE DELIRIUM; GERIATRIC SYNDROMES; OLDER-ADULTS; OUTCOMES; MEDICATIONS; PREDICTOR; FITNESS; INDEX; MEN;

D O I：

10.1111/jgs.16907

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Background Frailty in older vascular surgery patients is associated with increased mortality, hospital stay, and morbidity. The association of frailty with hospital-acquired geriatric syndromes such as delirium and functional decline has not been well studied. Objectives To investigate the association between frailty and hospital-acquired geriatric syndromes in older hospitalized vascular surgery patients, and to evaluate the prognostic performance of the frailty index (FI) and the Clinical Frailty Scale (CFS) for delirium and functional decline. Design Prospective cohort study. Setting Acute care academic hospital. Participants Patients aged 65 years or more admitted to a tertiary vascular surgery unit (N=150). Measurements Frailty was assessed using the FI and CFS. The adjusted association of frailty status with delirium and functional decline was assessed using logistic regression analysis. The prognostic performance of FI and CFS was determined by assessing C-statistic and positive and negative predictive values (PPV and NPV). Results Of 150 participants, FI identified 34 (23%) and CFS identified 45 (30%) as frail. Frailty was an independent predictor of delirium (FI adjusted odds ratio, odds ratio (OR) = 5.66, 95% confidence interval (CI) = 1.53-21.03; CFS adjusted OR = 4.07, 95% CI = 1.14-14.50), but not functional decline. FI and CFS showed acceptable prognostic performance for delirium (C-statistic 0.74), but not functional decline (C-statistic 0.63-0.64). For both outcomes, the FI and CFS had high NPV (86-96%), and low PPV (22-29%). Conclusion Frail older vascular surgery patients are more likely to develop hospital-acquired geriatric syndromes. The FI and CFS have acceptable prognostic performance for predicting delirium but not all individuals who are identified as frail develop delirium. Ongoing research is needed to identify interventions that improve outcomes in patients who screen positive for frailty.

引用

页码：688 / 695

页数：8

共 47 条

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