Influencing Factors Of Preoperative Frailty And Its Predictive Efficacy In Elderly Patients Undergoing Elective Abdominal Surgery

Objective1.To investigate preoperative frailty of elderly patients undergoing elective abdominal surgery and to explore its influencing factors.2.To study the correlation between preoperative frailty and short-term prognosis after abdominal surgery,and to explore its predictive value.Methods1.A total of 156 elderly patients undergoing elective hepatobiliary and gastrointestinal surgery from July to December 2017 in a first-class comprehensive hospital of Tianjin were selected according to the convenience sampling method.The data were investigated by questionnaires of general condition,comprehensive geriatric assessment and Fried frailty phenotype and the influencing factors of preoperative frailty in elderly patients undergoing elective abdominal surgery were screened out by univariate analysis and ordered Logistic regression analysis.2.A total of 156 elderly patients undergoing abdominal surgery from July 2017 to December 2017 in a first-class comprehensive hospital of Tianjin were prospectively observed and classified into non-frail group,pre-frail group and frail group according to the Fried's frailty phenotype before surgery.The postoperative hospital stay and incidence of adverse outcomes were compared among the three groups,and the effect of frailty on the risk prediction model of the American Society of Anesthesiology(ASA)was analyzed.Results1.Among 156 elderly patients undergoing elective abdominal surgery,the number of robust,pre-frail and frail patients were 51(32.7%),48(30.8%)and 57(36.5%),respectively.The results of univariate analysis showed that there were significant differences in age,central obesity,educational level,marital status,living status,family monthly income,physical exercise,health self-assessment status,ability of daily living(ADL),instrumental ability of daily living(IADL),balance function,cognitive status,depression,malnutrition,comorbidity,polypharmacy,decreased vision,hearing loss,oral problems,urinary incontinence,sleep disorders,and pain scores(P<0.05).The results of ordered Logistic regression analysis showed that aging,solitary living,low income,poor self-rated health,decreased ADL andbalance function,cognitive impairment,depression and malnutrition were risk factors of preoperative frailty in elderly patients undergoing elective abdominal surgery(P<0.05).2.The postoperative hospital stay of the elderly patients in the non-frail group,pre-frail group and frail group was(6.50±4.08)d,(9.45±8.10)d and(12.14±7.05)d,respectively,with statistically significant differences(F=7.46,P<0.001).The incidence of postoperative adverse outcomes in the three groups was statistically significant(c 2=23.30,P<0.001).Negative binomial regression analysis found that preoperative frailty was associated with prolonged postoperative hospital stay(pre-frail incidence rate ratio was 1.428(95%CI:1.250-1.974);frail incidence rate ratio was 3.692(95%CI:1.282-4.230).Logistic regression analysis found that preoperative frailty was associated with an increased risk of postoperative adverse outcomes(pre-frail:OR=2.303(95%CI:1.810-4.127);frail:OR=3.512(95%CI:2.054-5.689)).Frailty increased the diagnostic value of the ASA risk prediction model(Z=3.718,P<0.01).Conclusion1.Preoperative frailty in elderly patients undergoing elective surgery is not optimistic and affected by many factors.We should pay attention to patients' frailty,identify potential risks,and take multi-disciplinary,multi-angle measures to optimize preoperative conditions,so as to reduce the incidence of postoperative adverse events.2.Frailty of elderly patients is an important predictor of short-term prognosis of abdominal surgery and it increases the diagnostic value of ASA risk model.The preoperative frailty assessment of elderly patients undergoing abdominal surgery is helpful for preoperative clinical decision-making and prognosis evaluation.