The Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational Study
| Autor: | Laurence Roediger, Marie Bernard Hubert, Philippe Amabili, Aaron Wozolek, Jean-François Brichant, Anne-Françoise Donneau, Grégory Hans, Marc Senard, Ines Noirot |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Frail Elderly 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Risk Factors 030202 anesthesiology law Clinical endpoint medicine Humans Hospital Mortality Prospective Studies Cardiac Surgical Procedures Mortality Aged Aged 80 and over Receiver operating characteristic business.industry Incidence (epidemiology) EuroSCORE Intensive care unit Confidence interval Cardiac surgery Anesthesiology and Pain Medicine Emergency medicine Female Observational study Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 33:945-952 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2018.05.038 |
| Popis: | Objectives To investigate whether the Edmonton Frail Scale (EFS), a multidimensional frailty assessment tool, improves the prediction of 30-day or in-hospital mortality over the use of the European System for Cardiac Outcome Risk Evaluation (EuroSCORE) II alone. Design Single-center prospective observational study. Setting University hospital. Participants Patients aged 75 years or older undergoing cardiac surgery between February 2014 and May 2017. Intervention No intervention was performed. The EFS was administered the day before surgery. Measurements and Main Results The primary endpoint was 30-day or in-hospital mortality. Secondary endpoints were times to discharge from the intensive care unit (ICU) and from the hospital, discharge to a health care facility, and ability to return home by postoperative day 30. The EFS had a good discriminative ability for 30-day mortality (area under the receiver operating characteristic curve = 0.69; 95% confidence interval [CI], 0.56-0.82). Adding frailty, defined by an EFS ≥8, to the EuroSCORE II significantly improved the prediction of 30-day (p = 0.04) mortality. The integrated discrimination index was 0.03 (95% CI, 0.01-0.06, p = 0.01), meaning that the difference in predicted risk between patients who died and those who survived increased by 3% due to the addition of frailty determined by the EFS to the EuroSCORE II. Frailty also was associated significantly with a decreased cumulative probability of discharge from the ICU (p = 0.02) and an increased incidence of discharge to a health care facility (p = 0.01). Conclusion The EFS has a good predictive ability for 30-day mortality after cardiac surgery in elderly patients and improves the prediction of 30-day mortality over the use of the EuroSCORE II. |
| Databáze: | OpenAIRE |
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