Influence of Frailty on Outcome in Older Patients Undergoing Non-Cardiac Surgery - A Systematic Review and Meta-Analysis.
Influence of Frailty on Outcome in Older Patients Undergoing Non-Cardiac Surgery - A Systematic Review and Meta-Analysis.
复制标题
DOI：
10.14336/ad.2019.1024
复制
发表时间：
2020-10
影响因子：
7.4
通讯作者：
Hoeks SE
中科院分区：
文献类型：
--
作者：
Tjeertes EKM;van Fessem JMK;Mattace-Raso FUS;Hoofwijk AGM;Stolker RJ;Hoeks SE
人们越来越认识到，与实际年龄相比，虚弱是术后不良事件更好的预测指标。本综述的目的是系统评估虚弱对术后发病率和死亡率的影响。如果患者接受非心脏手术，以及是否通过使用身体、认知和功能领域的经过验证的仪器测量虚弱程度，则纳入研究。使用 EMBASE、MEDLINE、Web of Science、CENTRAL 和 PubMed 从 1990 年至 2017 年进行系统检索。使用预后研究评估工具评估方法学质量。结果包括 30 天死亡率和并发症、一年死亡率、术后谵妄和出院地点。使用随机效应模型进行荟萃分析，并将其呈现为具有置信区间和预测区间的汇总风险比。我们纳入了 56 项研究，涉及 1,106,653 名患者。使用了十一种衰弱评估工具。虚弱会增加 30 天死亡风险（31 项研究，673.387 名患者，风险比 3.71 [95% CI 2.89-4.77]（PI 1.38-9.97；I2=95%）和 30 天并发症风险（37 项研究，627.991 名患者，RR 2.39 [95% CI 2.02-2.83）。 1 年死亡率高出三倍（六项研究，341.769 名患者，RR 3.40 [95% CI 2.42-4.77]）。四项研究（N=438）报告术后谵妄的风险显着增加（RR 2.13 [95% CI 1.23-3.67）。最后，体弱的患者住院治疗的风险较高（10 项研究，RR）。 2.30 [95% CI 1.81-2.92]），虚弱与术后并发症、谵妄、住院和死亡的风险密切相关。术前虚弱评估可作为患者和医生决定谁能从手术中受益或谁不能受益的工具。
Frailty is increasingly recognized as a better predictor of adverse postoperative events than chronological age. The objective of this review was to systematically evaluate the effect of frailty on postoperative morbidity and mortality. Studies were included if patients underwent non-cardiac surgery and if frailty was measured by a validated instrument using physical, cognitive and functional domains. A systematic search was performed using EMBASE, MEDLINE, Web of Science, CENTRAL and PubMed from 1990 - 2017. Methodological quality was assessed using an assessment tool for prognosis studies. Outcomes were 30-day mortality and complications, one-year mortality, postoperative delirium and discharge location. Meta-analyses using random effect models were performed and presented as pooled risk ratios with confidence intervals and prediction intervals. We included 56 studies involving 1.106.653 patients. Eleven frailty assessment tools were used. Frailty increases risk of 30-day mortality (31 studies, 673.387 patients, risk ratio 3.71 [95% CI 2.89-4.77] (PI 1.38-9.97; I2=95%) and 30-day complications (37 studies, 627.991 patients, RR 2.39 [95% CI 2.02-2.83). Risk of 1-year mortality was threefold higher (six studies, 341.769 patients, RR 3.40 [95% CI 2.42-4.77]). Four studies (N=438) reported on postoperative delirium. Meta-analysis showed a significant increased risk (RR 2.13 [95% CI 1.23-3.67). Finally, frail patients had a higher risk of institutionalization (10 studies, RR 2.30 [95% CI 1.81- 2.92]). Frailty is strongly associated with risk of postoperative complications, delirium, institutionalization and mortality. Preoperative assessment of frailty can be used as a tool for patients and doctors to decide who benefits from surgery and who doesn’t.