BACKGROUND A multidisciplinary approach to improve postoperative outcomes in frail elderly patients is gaining interest. Multidisciplinary team care should be targeted at complex patients at high risk for adverse postoperative outcome to limit the strain on available resources and to prevent an unnecessary increase in patient burden. This study aimed to improve patient selection for multidisciplinary care by identifying risk factors for disability after cardiac surgery in elderly patients. METHODS This was a two-centre prospective cohort study of 537 patients aged ≥70 yr undergoing elective cardiac surgery. Before surgery, 11 frailty characteristics were investigated. Outcome was disability at 3 months defined as World Health Organization Disability Assessment Schedule 2.0 ≥25%. Multivariable modelling using logistic regression, concordance statistic (c-statistic), and net reclassification index was used to identify factors contributing to patient selection. RESULTS Disability occurred in 91 (17%) patients. Ten out of 11 frailty characteristics were associated with disability. A multivariable model, including the European System for Cardiac Operative Risk Evaluation II and preoperative haemoglobin, yielded a c-statistic of 0.71 (95% confidence interval [CI]: 0.66-0.77). After adding pre-specified frailty characteristics (polypharmacy, gait speed, physical disability, preoperative health-related quality of life, and living alone) to this model, the c-statistic improved to 0.78 (95% CI: 0.73-0.83). The net reclassification index was 0.32 (P<0.001), showing improved discrimination for patients at risk for disability at 3 months. CONCLUSIONS The addition of preoperative frailty characteristics to a multivariable model improved discrimination between elderly patients with and without disability at 3 months after cardiac surgery, and can be used to guide patient selection for preoperative multidisciplinary team care. CLINICAL TRIAL REGISTRATION NCT02535728.

中文翻译：

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麻醉老年学评估可指导患者选择心脏外科手术前的多学科团队护理。

背景技术改善脆弱的老年患者的术后结果的多学科方法正在引起人们的兴趣。多学科团队护理应针对术后不良后果风险高的复杂患者，以限制对可用资源的压力并防止不必要地增加患者负担。这项研究旨在通过识别老年患者心脏手术后致残的危险因素，改善对多学科护理的患者选择。方法这是一项针对537例≥70岁的接受择期心脏手术的患者的两中心前瞻性队列研究。手术前，研究了11个脆弱特征。结果是定义为世界卫生组织残疾评估表2.0≥25％的3个月时的残疾。使用逻辑回归的多变量建模，一致性统计（c-statistic）和净重分类指数用于确定有助于患者选择的因素。结果残疾发生在91名患者中（17％）。11个脆弱特征中有10个与残疾有关。一个多变量模型，包括欧洲心脏手术风险评估系统II和术前血红蛋白，产生的c统计量为0.71（95％置信区间[CI]：0.66-0.77）。在此模型中添加了预先指定的脆弱特征（多药店，步态速度，身体残疾，术前健康相关的生活质量和独居）后，c统计量提高到0.78（95％CI：0.73-0.83）。净重分类指数为0.32（P <0.001），显示对3个月内有残疾风险的患者的分辨力得到了改善。结论在多变量模型中增加术前虚弱特征可改善心脏手术后3个月时有残疾和无残疾的老年患者之间的区别，并可用于指导患者选择术前多学科团队护理。临床试验注册NCT02535728。