MP04-15 THE PREVALENCE AND IMPACT OF PREOPERERATIVE FRAILTY: A PROSPECTIVE STUDY OF PATIENTS UNDERGOING CYSTECTOMY
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Résumé
You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2017MP04-15 THE PREVALENCE AND IMPACT OF PREOPERERATIVE FRAILTY: A PROSPECTIVE STUDY OF PATIENTS UNDERGOING CYSTECTOMY Conrad Tobert, Nathan Brooks, Lewis Thomas, Chermaine Hung, Sarah Bell, and Kenneth Nepple Conrad TobertConrad Tobert More articles by this author , Nathan BrooksNathan Brooks More articles by this author , Lewis ThomasLewis Thomas More articles by this author , Chermaine HungChermaine Hung More articles by this author , Sarah BellSarah Bell More articles by this author , and Kenneth NeppleKenneth Nepple More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.153AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Perioperative morbidity is common amongst patients undergoing radical cystectomy. Frailty (decreased functional reserve) measurement has been proposed to identify at-risk patients, but there has been limited comparative prospective analysis of different frailty measures. METHODS 98 cystectomy patients at our institution from January 2015 to September 2016 were prospectively evaluated preoperatively, using the protocols for the four frailty indices: Duke Activity Status Index (DASI), Edmonton Frailty Index (EFI), Fried Frailty Index (FFI) and Schonberg Mortality Index (SMI) by a urology resident. Consensus Statement malnutrition assessment was performed by a dietitian. We examined the relationship between frailty, patient characteristics (age, neoadjuvant chemotherapy, malnutrition), and outcomes (length of stay 30-day readmission, 30-day Clavien grade > 2) were examined. RESULTS Median DASI was 39.4 (IQR: 26.9, 58.2), median EFI was 3 (IQR: 2, 4.2), median FFI was 2 (IQR: 1, 3), and median SMI was 12 (IQR: 9.7, 15). The median age of cystectomy patients was 71 years (IQR: 62, 77). 66 of 98 (67.3%) patients underwent neoadjuvant chemotherapy while preoperative malnutrition was present in 32 of 98 (32.6%) patients. With respect to outcomes: median length of stay was 7 days (IQR: 5, 8), 30-day readmission rate was 25.8%, and the 30-day complication rate was 41.8%. The associations of variables with the four frailty indices are displayed in Table 1. Increased age was significantly associated with all four indices. Neoadjuvant chemotherapy was only associated with the FFI (p=0.04). The presence of malnutrition was associated with the EFI (p=0.02), FFI (p<0.01), and SMI (p=0.04). The SMI was only index related to postoperative outcomes, as increased SMI was associated with both 30-day complications (p=0.04) and 30-day readmission (p<0.01). CONCLUSIONS Different frailty indices appear to measure different aspects of functional status. In this prospective evaluation, frailty was associated with age, malnutrition, and complications to varying degrees. The SMI was the strongest predictor of readmission and postoperative complications in patients undergoing cystectomy. Evaluation of patients preoperatively can be used to better counsel patients about postoperative complication risk. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e34 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Conrad Tobert More articles by this author Nathan Brooks More articles by this author Lewis Thomas More articles by this author Chermaine Hung More articles by this author Sarah Bell More articles by this author Kenneth Nepple More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».