RESUMO
BACKGROUND: Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population. AIM: To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery. METHODS: This single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected baseline data on the participants and administered three scales to assess frailty: The comprehensive geriatric assessment (CGA), Fried phenotype and FRAIL scale. The outcome measures were the postoperative severe complications and increased hospital costs. RESULTS: The prevalence of frailty when assessed with the CGA was 65.9%, 47.6% when assessed with the Fried phenotype, and 34.9% when assessed with the FRAIL scale. Using the CGA as a reference, kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale (both P < 0.001). Postoperative severe complications and increased hospital costs were observed in 29 (12.7%) and 57 (24.9%) patients, respectively. Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs (odds ratio = 2.298, 95% confidence interval: 1.044-5.057; P = 0.039). None of the frailty assessment tools were associated with postoperative severe complications. CONCLUSION: The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastrointestinal cancer.
RESUMO
According to the operative characteristics, the stimulated site and the curative effect-emerged site of bloodletting therapy, its clinical characteristics may be divided into three categories: a) local stimulation induced focus-local effect, b) local stimulation induced effect of the distal target organ (point-to-point distal effect), and c) special point stimulation induced broader effect of the whole body. Accordingly, the underlying mechanisms of clinical outcomes mainly involve the improvement of the local microcirculation and secondary changes of inflammatory substances for the first category (local focus). The point-to-point distal effect might mainly involve the innervation of nerve segments, while the broad effect of specific acupoint stimulation might involve multiple levels of the neuro-endocrine-immune system. The future research on the mechanisms of bloodletting should starts from its specific effects and the type of disease, which should not be generalized.
