Abstract: Background　The proportion of elderly patients in the surgical operation increases year by year and is accompanied by a higher incidence of adverse outcomes. More and more evidence shows that preoperative frailty is a risk factor for postoperative adverse outcomes. Objective　To investigate preoperative frailty of elderly patients undergoing elective abdominal surgery and to explore its influencing factors. Methods　A total of 156 elderly patients undergoing elective hepatobiliary and gastrointestinal surgery from July to December 2017 in Tianjin Third Central Hospital were selected according to the convenience sampling method. The data were investigated by questionnaires of general condition， comprehensive geriatric assessment and FRIED frailty phenotype and the influencing factors of preoperative frailty in elderly patients undergoing elective abdominal surgery were screened out by univariate analysis and ordered Logistic regression analysis. Results　Among 156 elderly patients undergoing elective abdominal surgery， the number of robust， pre-fragile and fragile patients were 51 （32.7%）， 48 （30.8%） and 57 （36.5%）， respectively. The results of univariate analysis showed that there were significant differences in age， central obesity， educational level， marital status， living status， family monthly income， physical exercise， health self-assessment status， ability of daily living （ADL）， instrumental ability of daily living （IADL）， balance function， cognitive status， depression，innutrition， comorbidity， polypharmacy， decreased vision， hearing loss， oral problems， urinary incontinence， sleep disorders， and pain scores （P<0.05）．The results of ordered Logistic regression analysis showed that aging， solitary living， low income， poor self-rated health， decreased ADL and balance function， dementia， depression and malnutrition were risk factors of preoperative frailty in elderly patients undergoing elective abdominal surgery （P<0.05）．Conclusion　Preoperative frailty in elderly patients undergoing elective surgery is not optimistic and affected by many factors. We should pay attention to patients' frailty， identify potential risks， and take multi-disciplinary，multi-angle measures to optimize preoperative conditions， so as to reduce the incidence of postoperative adverse events.

Key words: Frailty, Abdominal operation, Comprehensive geriatric assessment, Aged, Root cause analysis

摘要： 背景　老年患者在外科手术中占比逐年增高且伴有较高的不良结局发生率，越来越多证据表明术前衰弱是术后不良结局的危险因素。目的　调查腹部择期手术老年患者的术前衰弱状况并探讨其影响因素。方法　采取便利抽样的方法，选取天津市第三中心医院于2017年7—12月进行腹部择期肝胆及胃肠手术的老年患者156例，采用一般情况问卷、老年综合评估问卷、FRIED衰弱表型评估方法进行调查，并采用单因素分析和有序多分类Logistic回归分析，筛选出腹部择期手术老年患者术前衰弱的影响因素。结果　156例腹部择期手术老年患者中，健康状态、衰弱前期和衰弱者分别为51例（32.7%）、48例（30.8%）和57例（36.5%）。单因素分析结果显示，不同年龄、向心性肥胖、文化程度、婚姻情况、居住情况、家庭月收入、锻炼情况、健康自评、日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）、平衡功能、认知情况、有无抑郁、不同营养情况、有无多病共存、多重用药、视力下降、听力下降、口腔问题、尿失禁、不同睡眠障碍、疼痛情况老年患者术前衰弱状况比较，差异均有统计学意义（P<0.05）。多分类Logistic回归分析结果显示，增龄、独居、低收入、健康自评差、ADL非独立、平衡功能下降、认知情况为痴呆、抑郁、营养情况为有营养不良风险及营养不良均为腹部择期手术老年患者术前衰弱的危险因素（P<0.05）。结论　腹部择期手术老年患者的术前衰弱状况不容乐观，且受多种因素影响，术前应重视患者的衰弱状况，识别潜在的风险，并从多学科多角度及时采取措施予以术前优化，以降低术后不良事件的发生。

关键词: 衰弱, 腹部手术, 老年综合评估, 老年人, 影响因素分析