Research On Preoperative Frailty In Elderly Patients Undergoing Thoracoscopic Lobectomy And Its Relationship With Postoperative Pulmonary Complications

Objective: To investigate the research status and influencing factors of preoperative frailty in elderly patients undergoing thoracoscopic lobectomy;To investigate the relationship between preoperative frailty and postoperative pulmonary complications(PPCs)in elderly patients undergoing thoracoscopic lobectomy;To clarify frailty combined with common pulmonary complications risk assessment tools can more effectively predict PPCs.Methods: This study includes two parts: descriptive research and prospective research.Part I: the information of elderly patients with non-small cell lung cancer who underwent elective thoracoscopic lobectomy in the Affiliated Hospital of Jiangnan Universityi from December 2020 to December 2021 was collected.A total of 423 patients participated in this study.The general situation questionnaire,frailty scale,activity of daily living,geriatric depression scale-5,self-rating anxiety scale,pittsburgh sleep quality index,mini-mental state examination and mini-nutritional assessment short-form were used as research tools,and the research status and influencing factors of preoperative frailty were analyzed by univariate analysis and disordered multi-classification logistic regression.Part II: The American Society of Anesthesiologists(ASA)classification and PPC risk index were used as PPCs risk assessment tools.All patients were followed up to the day of discharge and the occurrence of PPCs was recorded.Univariate analysis and multivariate logistic regression model were used to evaluate the relationship between preoperative frailty and PPCs.Stratified analysis and interaction test were carried out to further explore whether there are differences in the relationship between preoperative frailty and PPCs in different subgroups.The predictive effects of frailty combined with PPCs risk assessment tool on PPCs were evaluated by receiver operating characteristic(ROC)curve.Results:(1)Among 423 elderly patients undergoing thoracoscopic lobectomy,the incidence of pre-frail patients was 43.3%,and the prevalence of frail patients was 27.7%.(2)Univariate analysis showed that age,smoking,anxiety,depression,sleep disorders,activities of daily living,cognitive function,hypertension,liver and kidney dysfunction,malnutrition and chronic obstructive oulmonary disease(COPD)were the influencing factors of frailty in elderly patients undergoing thoracoscopic lobectomy(P < 0.05).(3)The results of disordered multi-classification logistic regression analysis showed that the impairment of activities of daily living and cognitive impairment were the influencing factors of pre-frailty and frailty in elderly patients undergoing thoracoscopic lobectomy(P <0.05).Age,depression,sleep disorder,hypertension,malnutrition and COPD were independent factors of preoperative frailty in elderly patients undergoing thoracoscopic lobectomy(P < 0.05).(4)From follow-up to the day of discharge,after adjusted for all confounding factors,multivariate logistic regression showed that frailty was an independent predictor of PPCs in elderly patients undergoing thoracoscopic lobectomy(OR = 6.98,95% CI: 3.51 ～ 13.89,P <0.05).(5)The area under curve of frailty combined with ASA grade in predicting the occurrence of PPCs in elderly patients undergoing thoracoscopic lobectomy was 0.779(95 %CI:0.728 ～ 0.831),which was significantly higher than that of ASA grade alone(P <0.05);The area under curve of frailty combined with PPC risk index in predicting PPCs was0.847(95 %CI:0.808 ～ 0.886),which was significantly higher than that of PPC risk index alone(P < 0.05).(6)Frailty was an independent risk factor for postoperative atelectasis,respiratory tract infection,pleural effusion,pneumothorax,respiratory failure and mechanical ventilation in elderly patients undergoing thoracoscopic lobectomy(P < 0.05).Conclusion: The incidence of preoperative frailty in elderly patients undergoing thoracoscopic lobectomy was 27.7%.Activities of daily living disorder and cognitive impairment were the influencing factors of pre frailty and frailty in elderly patients undergoing thoracoscopic lobectomy.Age,depression,sleep disorder,hypertension,malnutrition and COPD were independent factors of preoperative frailty in elderly patients undergoing thoracoscopic lobectomy.From the follow-up to the day of discharge,we found frailty was an independent predictor of PPCs in elderly patients undergoing thoracoscopic lobectomy.Frailty combined with common PPCs risk assessment tools can more effectively predict the incidence of PPCs.