Development And Validation Of Early Prediction Model For New-onset Disability Or Death After Elective Non-cardiac Major Surgery In Elderly Patients

Part Ⅰ Incidence and Risk Factors of Disability After Non-cardiac Surgery in Adult Patients:a systematic review and meta-analysisBackgroundDisability is a common complication after non-cardiac surgery,and considered to be associated with readmission and mortality after surgery.Therefore,disability has become an important part of global disease burden.The present study aimed to synthesize the data from studies with respect to the incidence and risk factors for disability after non-cardiac surgery.MethodsPubMed and EMBASE were searched for articles published between inception and June 2022.Studies that enrolled patients undergoing non-cardiac surgery and reported the outcome of postoperative functional disability were included.The selection of literatures and quality evaluation were conducted independently by two reviewers.Random-effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidence of postoperative disability.ResultsTwenty-seven articles reporting 25 unique cohorts that enrolled 74896 consecutive patients were included.In 16 studies,the pooled incidence of postoperative AKI was 23%(95%confidence interval(CI)15-31%).The age(OR 1.17,95%CI 1.03-1.32),emergency procedures(OR 1.20,95%CI 1.06-1.36),preoperative functional status(OR 1.87,95%CI 1.04-3.36),cognitive impairment(OR 1.77,95%CI 1.59-1.98),cancer(OR 2.21,95%CI 1.57-3.12),fall history(OR 2.48,95%CI 1.25-4.94),malnutrition(OR 2.04,95%CI 1.28-3.24)and preoperative mobility aid(OR 1.67,95%CI 1.58-1.77)were associated with postoperative disability.ConclusionPostoperative disability is common after non-cardiac surgery.We identified potentially modifiable prognostic factors(e.g.older age,cognitive impairment,cancer,fall history,malnutrition and preoperative mobility aid)associated with postoperative disability that can be targeted preoperatively to optimize medical care.Part Ⅱ Development and Validation of Early Prediction Model for New-onset Disability or Death After Elective Non-cardiac Major Surgery in Elderly PatientsBackgroundSince the population is expanding and aging,more and more elderly patients undergo surgery and expect better functional status after surgical therapy.New-onset disability is a complication that have adverse impact on patients’ quality of recovery.The purpose of this study was to develop a predictive model for new-onset disability or death after non-cardiac surgery.MethodsPotential prognostic factors were included in analysis according to the conclusion of the previous meta-analysis,clinically practical experience and literature,and data originated from a prognostic cohort study(PREdiction of Vascular Events after major Non-cardiac surGEry,PREVENGE)were available.The primary outcome was the composite of new-onset disability or all-caused death in 180 days after major non-cardiac surgery.The model was developed by multivariate logistic regression analysis.Discrimination and calibration were used to evaluate the performance of the model.The Bootstrap method was used for internal validation.Finally,the prediction model was presented as a nomogram.ResultsA total of 1846 patients were included and the incidence of new-onset disability or death after non-cardiac surgery was 18.2%(336/1846).Independent predictors of the primary composite outcome were age,surgery types,N-terminal pro-B-type natriuretic peptide,hypersensitive troponin T,anemia,hypoalbuminemia,malnutrition and Charlson Comorbidity Index.The model’s predictive performance for discrimination was good,since the area under the curve(AUC)was 0.734(95%CI 0.705-0.763).The Hosmer-Lemeshow test showed that the Goodness of Fit of model was acceptable(P=0.426>0.05).ConclusionA preoperative risk prediction model consisting of eight predictors for postoperative disability or death was developed,with good predictive performance in elderly patients undergoing non-cardiac surgery.Early identification of patients at high risk of postoperative disability or death may support decision making for enhanced rehabilitation interventions perioperatively.