Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis.
Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis.
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全面的老年护理模型对老年外科患者术后结局的影响：系统的综述和荟萃分析。
DOI：
10.1186/s12871-021-01337-2
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发表时间：
2021-04-22
影响因子：
2.2
通讯作者：
Chung F
中科院分区：
文献类型：
--
作者：
Saripella A;Wasef S;Nagappa M;Riazi S;Englesakis M;Wong J;Chung F
老年人群在大手术后极易发生术后并发症。目前尚不清楚全面的老年护理模式是否能有效减少不良事件。本系统综述和荟萃分析的目的是确定综合老年护理模式是否改善了临床结局，特别是在降低老年手术患者谵妄的患病率和住院时间（LOS）方面。我们检索了Medline、PubMed、Embase、科克伦对照试验中心注册库、科克伦系统评价数据库、Emcare Nursing、Web of Science、Scopus、CINAHL、ClinicalTrials。Gov和ICTRP在2009年至2020年1月23日期间。我们纳入了关于接受择期非心脏高风险手术的老年患者（≥60岁）的老年护理模式的研究。结果是谵妄的患病率、LOS、30天再入院率和30天死亡率。我们使用了科克伦审查管理器5.3版。采用随机效应模型分析，估计合并优势比（OR）和平均差（MD）。11项研究纳入了2672例患者[随机对照试验（RCT）：4;非随机对照试验（Non-RCT）：7]。6项研究的汇总数据显示，干预组和对照组之间的谵妄患病率无显著差异：13.8% vs 15.9%（OR：0.76; 95%CI：0.30-1.96; p = 0.57）。同样，在LOS中也没有显著差异（MD：-0.55; 95% CI：-2.28，1.18; p = 0.53），30天再入院（12.1% vs. 14.3%; OR：1.09; 95% CI：0.67-1.77; p = 0.73）和30天死亡率（3.2% vs. 2.1%; OR：1.34; 95% CI：0.66-2.69; p = 0.42）。证据的质量很低。老年护理模式包括术前综合老年评估和干预工具，以解决认知，虚弱和功能状态。在非心脏高风险手术中，这些护理模式在老年患者的谵妄患病率、LOS、30天再入院率和30天死亡率方面没有显示出任何显著差异。需要进一步的随机对照试验来评价这些模型对术后结局的影响。PROSPERO注册号-CRD 42020181779。在线版本包含补充材料，可通过10.1186/s12871-021-01337-2获得。
The elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes, particularly in decreasing the prevalence of delirium and length of hospital stay (LOS) in elderly surgical patients. We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We included studies on geriatric care models in elderly patients (≥60 years) undergoing elective, non-cardiac high-risk surgery. The outcomes were the prevalence of delirium, LOS, rates of 30-days readmission, and 30-days mortality. We used the Cochrane Review Manager Version 5.3. to estimate the pooled Odds Ratio (OR) and Mean Difference (MD) using random effect model analysis. Eleven studies were included with 2672 patients [Randomized Controlled Trials (RCTs): 4; Non-Randomized Controlled Trials (Non-RCTs): 7]. Data pooled from six studies showed that there was no significant difference in the prevalence of delirium between the intervention and control groups: 13.8% vs 15.9% (OR: 0.76; 95% CI: 0.30–1.96; p = 0.57). Similarly, there were no significant differences in the LOS (MD: -0.55; 95% CI: − 2.28, 1.18; p = 0.53), 30-day readmission (12.1% vs. 14.3%; OR: 1.09; 95% CI: 0.67–1.77; p = 0.73), and 30-day mortality (3.2% vs. 2.1%; OR: 1.34; 95% CI: 0.66–2.69; p = 0.42). The quality of evidence was very low. The geriatric care models involved pre-operative comprehensive geriatric assessment, and intervention tools to address cognition, frailty, and functional status. In non-cardiac high-risk surgeries, these care models did not show any significant difference in the prevalence of delirium, LOS, 30-days readmission rates, and 30-day mortality in geriatric patients. Further RCTs are warranted to evaluate these models on the postoperative outcomes. PROSPERO registration number - CRD42020181779. The online version contains supplementary material available at 10.1186/s12871-021-01337-2.
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影响因子：
15.8
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
3.7
作者：
Hempenius, Liesbeth;Slaets, Joris P. J.;van Leeuwen, Barbara L.
通讯作者：
van Leeuwen, Barbara L.
DOI：
10.1046/j.1532-5415.2003.51465.x
发表时间：
2003-10-01
影响因子：
6.3
作者：
Borson, S;Scanlan, JM;Ganguli, M
通讯作者：
Ganguli, M
影响因子：
3.7
作者：
Hempenius L;Slaets JP;van Asselt D;de Bock TH;Wiggers T;van Leeuwen BL
通讯作者：
van Leeuwen BL
影响因子：
6.7
作者：
Harari, Danielle;Hopper, Adrian;Martin, Finbarr
通讯作者：
Martin, Finbarr