Frailty and post-operative outcomes in older surgical patients: a systematic review.
Frailty and post-operative outcomes in older surgical patients: a systematic review.
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DOI：
10.1186/s12877-016-0329-8
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发表时间：
2016-08-31
期刊：
影响因子：
4.1
通讯作者：
Hubbard RE
中科院分区：
文献类型：
--
作者：
Lin HS;Watts JN;Peel NM;Hubbard RE
随着人口老龄化，越来越多的老年人接受手术。虚弱在老年人中普遍存在，并且可能是比实际年龄更好的术后发病率和死亡率的预测因素。本综述的目的是研究虚弱对“高龄老人”和“高龄老人”手术患者不良结局的影响。进行了系统审查。检索了2010年至2015年的电子数据库，以识别评价平均年龄为75岁及以上的手术人群中虚弱与术后结局之间关系的文章。如果文献为非英语语言或仅使用单一标记测量虚弱，则将其排除。从所选研究中提取人口统计学数据、手术类型、虚弱程度和虚弱对不良结局的影响。通过流行病学评估工具评估研究质量和偏倚风险。选择了23项研究进行审查，并将其评估为中等至高质量。平均年龄范围为75 - 87岁，包括接受心脏、肿瘤、普通、血管和髋部骨折手术的患者。有21种不同的仪器用于测量脆弱性。无论如何测量虚弱程度，就研究数量、结果的一致性和研究质量而言，最有力的证据是虚弱程度与30天、90天和1年随访时死亡率增加、术后并发症和住院时间之间的相关性。少数研究报告了出院到机构护理，功能下降和手术后生活质量降低，并发现与虚弱有显著相关性。有强有力的证据表明，年老和高龄手术患者的虚弱预示着术后死亡率、并发症和住院时间延长。虚弱评估可能是围手术期评估的一个有价值的工具。不同的脆弱性工具可能最适合不同的敏锐度和手术患者类型。虚弱与恢复到病前功能、出院目的地和术后生活质量之间的关系值得进一步研究。
As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the ‘older old’ and ‘oldest old’ surgical patients. A systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument. Twenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty. There was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that different frailty tools are best suited for different acuity and type of surgical patients. The association between frailty and return to pre-morbid function, discharge destination, and quality of life after surgery warrants further research.
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DOI：
10.1016/j.jamda.2009.09.015
发表时间：
2010-06-01
影响因子：
7.6
作者：
Gobbens, Robbert J. J.;Luijkx, Katrien G.;Schols, Jos M. G. A.
通讯作者：
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影响因子：
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影响因子：
1.6
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DOI：
10.1016/j.jamda.2013.03.022
发表时间：
2013-06
影响因子：
7.6
作者：
Morley JE;Vellas B;van Kan GA;Anker SD;Bauer JM;Bernabei R;Cesari M;Chumlea WC;Doehner W;Evans J;Fried LP;Guralnik JM;Katz PR;Malmstrom TK;McCarter RJ;Gutierrez Robledo LM;Rockwood K;von Haehling S;Vandewoude MF;Walston J
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