Study On The Relationship Between Postoperative Frailty And Short-term Prognosis In Elderly Patients With Gastrointestinal Tumors

Objective To investigate the current situation of postoperative frailty and its influencing factors in elderly patients with gastrointestinal tumor.To explore the relationship between postoperative frailty and short-term prognosis of the disease,so as to provide reference for clinical promotion of postoperative rehabilitation in elderly patients with gastrointestinal tumor.Methods A total of 378 elderly patients with gastrointestinal tumors who were scheduled for surgical treatment in the surgical ward of the Grade A Hospital in Anhui Province from December 2021 to August 2022 were screened according to the inclusion and exclusion criteria.The general information,frailty assessment data,preoperative data,intraoperative data,postoperative data and short-term prognosis data of patients were investigated.On the 5th day after surgery according to the Chinese version of Tilburg Frailty Indicator(TFI)the patients were diagnosed whether they developed postoperative frailty and were divided into postoperative frailty group and postoperative non-frailty group.The general information,preoperative,intraoperative and postoperative data of the two groups were analyzed by univariate analysis,and the influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors were explored by binary Logistic regression analysis.According to the prognosis data of the two groups,the relationship between postoperative frailty and short-term prognosis of the disease was analyzed.Descriptive analysis,t test,Chisquare test,rank sum test,Binary Logistic regression analysis were conducted with SPSS 23.0 software.Results(1)223(59.0%)patients postoperative frailty in this study.(2)The results of univariate analysis showed that the general information[age,education level,marital status,Body Mass Index(BMI),regular exercise],preoperative data[Charison Comorbid Index(CCI)score,preoperative frailty],intraoperative data[operation method,operation time,intraoperative blood loss,American Society of Anesthesiologists(ASA)grade,pathological stage,maximum tumor diameter]and postoperative data[early postoperative complications,hemoglobin,albumin,glomerular filtration rate,blood glucose,use of painkillers,Sleep Dysfunction Rating Scale(SDRS)score,15-Item Geriatric Depression Scale(GDS-15)score,20-Item Geriatric Anxiety Inventory(GAI-20)score,Barthel index score]were significantly different(P<0.05).(3)The results of binary Logistic regression analysis showed that age(OR=1.226,95%CI:1.117～1.346),preoperative frailty(OR=6.245,95%CI:1.566～24.911),operation time(OR=1.011,95%CI:1.005～1.017),early postoperative complications(OR=10.677,95%CI:1.852～61.558),hemoglobin(OR=6.398,95%CI:1.852～22.104),SDRS score(OR=1.191,95%CI:1.054～1.346),GDS-15 score(OR=2.329,95%CI:1.619～3.351),GAI-20 score(OR=1.286,95%CI:1.052～1.572)and Barthel index score(OR=0.765,95%CI:0.694～0.843)were the independent influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors(P<0.05).These nine independent variables explained 63.1%of the total variation of postoperative frailtys and the Hosmer-Lemeshow goodness-of-fit test model was well fitted χ2=7.189,P=0.516).(4)Two groups of patients in postoperative recovery of gastrointestinal function(first exhaust time of anus/enterostomy,first defecation time of anus/enterostomy,oral feeding time),total postoperative complications during hospitalization,postoperative adverse outcomes during hospitalization(admission to ICU),medical outcome(total hospitalization days,postoperative hospitalization days,total hospitalization expenses),postoperative recovery quality,unplanned readmission within 30 days after discharge were statistically significant(P<0.05),but there was no significant difference inhospital death and death within 30 days after discharge(P>0.05).Conclusions(1)The incidence of postoperative frailty in elderly patients with gastrointestinal tumors was higher.(2)Older age,preoperative frailty,long operation time,early postoperative complications,low hemoglobin,high SDRS score,high GDS-15 score,and high GAI-20 score were risk factors for postoperative frailty in elderly patients with gastrointestinal tumors,while high Barthel index score was protective factors.(3)Postoperative frailty was likely to lead to adverse postoperative outcomes.