Background Frailty, malnutrition and low socioeconomic status may mutually perpetuate each other in a self-reinforcing and interdependent manner. The intertwined nature of these factors may be overlooked when investigating impacts on perioperative outcomes. This study aimed to investigate the impact of frailty, malnutrition and socioeconomic status on perioperative outcomes. Methods A multicentre cohort study involving six Australian tertiary hospitals was undertaken. All consecutive surgical patients who underwent an operation were included. Frailty was defined by the Hospital Frailty Risk Score, malnutrition by the Malnutrition Universal Screening Tool (MUST) and low socioeconomic status by the Index of Relative Socioeconomic Disadvantage. Linear mixed-effects and binary logistic generalised estimated equation models were performed for the outcomes: inpatient mortality, length of stay, 30-day readmission and re-operation. Results A total of 21 976 patients were included. After controlling for confounders, malnutrition and socioeconomic status, patients at high risk of frailty have a mean hospital length of stay 3.46 times longer (mean ratio = 3.46; 95% confidence interval (CI): 3.20, 3.73; P value < .001), odds of 30-day readmission 2.4 times higher (odds ratio = 2.40; 95% CI: 2.19, 2.63; P value < .001) and odds of in-hospital mortality 12.89 times greater than patients with low risk of frailty (odds ratio = 12.89; 95% CI: 4.51, 36.69; P value < .001). Elevated MUST scores were also significantly associated with worse outcomes, but to a lesser extent. Socioeconomic status had no association with outcomes. Conclusion Perioperative risk evaluation should consider both frailty and malnutrition as separate, significant risk factors. Despite strong causal links with frailty and malnutrition, socioeconomic disadvantage is not associated with worse postoperative outcomes. Additional studies regarding the prospective identification of these patients with implementation of strategies to mitigate frailty and malnutrition and assessment of perioperative risk are required.

中文翻译：

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虚弱、营养不良和社会经济地位对围手术期结局的影响


背景 虚弱、营养不良和社会经济地位低下可能以自我强化和相互依存的方式相互延续。在调查对围手术期结局的影响时，这些因素的交织性质可能会被忽视。本研究旨在调查虚弱、营养不良和社会经济地位对围手术期结局的影响。方法 进行了一项涉及 6 家澳大利亚三级医院的多中心队列研究。包括所有接受手术的连续手术患者。虚弱由医院虚弱风险评分定义，营养不良由营养不良通用筛查工具 （MUST） 定义，低社会经济地位由相对社会经济劣势指数定义。对以下结局进行线性混合效应和二元 logistic 广义估计方程模型：住院死亡率、住院时间、30 天再入院和再次手术。结果 共纳入 21 976 例患者。在控制了混杂因素、营养不良和社会经济地位后，虚弱高风险患者的平均住院时间延长了 3.46 倍（平均比 = 3.46;95% 置信区间 （CI）：3.20、3.73;P 值 < .001），30 天再入院的几率高 2.4 倍（比值比 = 2.40;95% CI：2.19、2.63;P 值 < .001），院内死亡率比低虚弱风险患者高 12.89 倍（比值比 = 12.89;95% CI：4.51,36.69;P 值 < .001）。MUST 评分升高也与较差的结局显著相关，但程度较小。社会经济地位与结局无关。结论 围手术期风险评估应将虚弱和营养不良视为独立的重要危险因素。 尽管与虚弱和营养不良有很强的因果关系，但社会经济劣势与较差的术后结局无关。需要关于前瞻性识别这些患者并实施缓解虚弱和营养不良的策略以及围手术期风险评估的额外研究。