Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists.
Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists.
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脆弱的外科医生：美国国家衰老学院脆弱会议的审查专家。
DOI：
10.1016/j.jamcollsurg.2015.08.428
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发表时间：
2015-12
影响因子：
5.2
通讯作者：
Hurria A
中科院分区：
文献类型：
--
作者：
Robinson TN;Walston JD;Brummel NE;Deiner S;Brown CH 4th;Kennedy M;Hurria A
虚弱是卫生保健面临的最关键问题之一，因为它与卫生保健结果差有着内在的关系。在65岁及以上的人群中，有10%到20%的人虚弱，并且随着年龄的增长而增加。目前，美国有15%的人口年龄在65岁及以上；预计到2030年，这一数字将增加到21%。在美国，老年人占外科手术的很大一部分。2010年，在美国进行的所有住院手术中，有37%的患者年龄在65岁及以上，这一比例在未来几十年将会上升。鉴于人口老龄化不可避免的增加，外科医生理解虚弱的概念以及它如何影响手术决策和结果是至关重要的。为了解决这一知识差距，美国国家老龄化研究所和美国老年医学会于2015年3月2日至3日主办了为期两天的会议，专门讨论专家们的虚弱问题。脆弱管理和研究领域的全球领导者担任教职。这篇文章的目的是总结在临床相关的背景下，关于虚弱和围手术期管理的关键点。虚弱和手术结果老年人虚弱与不良手术结果密切相关。基线术前虚弱预测术后不良事件（表1）。一系列外科学科的多项研究一致将基线术前虚弱与不良手术结果联系起来，包括严重并发症、6-9延长住院时间、8需要出院到机构护理设施、7、8、10-12再入院、30天死亡率、12和长期死亡率。虚弱直到最近才在外科文献中得到承认；事实证明，“虚弱”一词直到2005年写给编辑的一封信才出现在主要外科杂志的标题中，而第一个科学出版物是在2009年。10
Frailty represents one of the most critical issues facing health care due to its inherent relationship with poor health care outcomes. Frailty is present in 10% to 20% of individuals 65 years and older 1, 2 and increases with advancing age. Currently, 15% of the United States population is 65 years and older; a number that is forecast to increase to 21% by the year 2030. 3 Older adults make up a large portion of surgical practice in the United States. In 2010, 37% of all inpatient operations performed in the United States were in patients 65 years and older, 4 and this percentage will rise in the coming decades. 5 Given the inevitable rise of the aging population, it is vital that surgeons understand the concept of frailty and how it may affect surgical decisions and outcomes. To address this gap in knowledge, the National Institute on Aging and the American Geriatrics Society sponsored a 2-day conference held March 2 and 3, 2015, specifically addressing the topic of frailty for specialists. Global leaders in frailty management and research served as faculty. The purpose of this manuscript is to summarize the key points regarding frailty and perioperative management in a clinically relevant context.FRAILTY AND SURGICAL OUTCOMES Frailty in older adults is closely associated with adverse surgical outcomes. Baseline preoperative frailty forecasts adverse postoperative events (Table 1). Multiple studies across a range of surgical disciplines consistently relate baseline preoperative frailty to poor surgical outcomes including serious complications, 6-9 prolonged length of stay, 8 need for discharge to an institutional care facility, 7, 8, 10-12 hospital readmission, 30-day mortality, 12 and long-term mortality. 10 Frailty has only recently been recognized in the surgical literature; a statement evidenced by the fact that the term frailty did not appear as a title word in a major surgical journal until a letter to the editor reported in 2005, 13 and the first scientific publication was in 2009. 10