| Objective To investigate the status of preoperative frailty in elderly patients with lumbar degenerative disease,analyze its influencing factors,and explore the influence of preoperative frailty on postoperative outcome,so as to provide a reference for clinical intervention measures,operation plans and nursing plans for elderly patients with frailty in the future.MethodsA prospective longitudinal study was conducted.A total of 280 elderly patients with lumbar degenerative disease who were scheduled for surgical treatment in the Department of Orthopedics of a tertiary general hospital in Hefei from June to November 2022 were selected.Demographic and disease information questionnaire,Tilburg Frailty Indicator,Barthel Index,Short-Form Mini-Nutritional Assessment,Hospital Anxiety and Depression Scale,Pittsburgh Sleep Quality Index were used to investigate the patients on the day of admission.272 valid samples were followed up for30 days after discharge to record postoperative outcomes,including the length of hospital stay,hospitalization cost,the occurrence of complications,unplanned secondary surgery and death within 30 days after surgery and unplanned readmission within 30 days after discharge.According to whether they were diagnosed as frail or not,they were divided into frail group and non-frail group.Logistic regression analysis was performed to screen out the influencing factors for frailty in elderly patients with lumbar degenerative diseases.The difference of surgical outcome between the frail and non-frail group was compared.The patients were divided into non-complication group and complication group according to whether they had postoperative complications.Logistic regression analysis was used to screen out the influencing factors for postoperative complications so as to explore the influence of preoperative frailty on postoperative outcome.Results1.In this study,272 elderly patients with lumbar degenerative disease underwent surgical treatment were included,The mean age was(68.22±5.32)years old,and the incidence of frailty was 15.8%(43/272).2.In univariate analysis of frailty,there were statistically significant differences in frailty incidence among elderly patients with lumbar degenerative disease with different gender,age,residence style,activities ability of daily living,fall history in the past year,hemoglobin value,albumin value,nutrition status,anxiety,depression and sleep status(P<0.05).3.Multivariate analysis of preoperative frailty showed that living alone(OR=14.013,95%CI:3.846～51.055,P<0.001),anxiety(OR=5.824,95%CI:1.265～26.822,P<0.05)and depression(OR=5.614,95%CI:1.163～27.108,P<0.05)were risk factors for frailty,which increased the risk of frailty.High albumin(OR=0.809,95%CI: 0.709～0.924,P<0.05)and activities ability of daily living(OR=0.946,95%CI: 0.920～0.972,P<0.001)were protective factors for frailty,the increase in albumin and activities ability of daily living reduces the risk of frailty.4.No patients died during the study.34 patients developed complications within 30 days after surgery,with a complication rate of 12.5%.The top three complications were incision infection,cerebrospinal fluid leakage,deep venous thrombosis of the lower extremities and pulmonary infection.5.The postoperative outcome of the two groups was compared.The incidence of postoperative complications in the frailty group was higher than that in the non-frailty group(37.2% VS.7.9%,P<0.001).The length of hospital stay and hospital expenses in the frailty group were higher than that in the non-frailty group(P < 0.001).The incidence of 30 day unplanned readmission in the frailty group were higher than that in the non-frailty group(16.3% VS.2.2%,P<0.001).No significant difference was found in the occurrence of unplanned second operation within 30 days after surgery between the two groups(P>0.05).6.Multivariate analysis of postoperative complications showed that frailty increased the risk of postoperative complications and was a risk factor for complications(OR=6.947,95%CI:3.173～15.208,P<0.001).ConclusionsThis study conducted a study on elderly patients with lumbar degenerative disease and found that patients had preoperative frailty,while living alone,anxiety and depression were risk factors for frailty,and high albumin and activities ability of daily living were protective factors for frailty.Further analysis showed that frailty was associated with poor postoperative outcomes and was a risk factor for postoperative complications.Therefore,frailty assessment should be carried out as soon as possible in elderly patients with lumbar degenerative disease and intervention should be carried out in time to delay or even reverse the process of frailty,avoid the adverse outcomes caused by it,and make patients benefit from surgical treatment to the greatest extent. |
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