Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures: A Systematic Review.
Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures: A Systematic Review.
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DOI：
10.7326/m16-0652
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发表时间：
2016-11-01
影响因子：
39.2
通讯作者：
Marcantonio ER
中科院分区：
文献类型：
--
作者：
Kim DH;Kim CA;Placide S;Lipsitz LA;Marcantonio ER
虚弱评估可以告知传统手术风险评分无法捕获的手术风险和预后。评价各种脆弱工具预测接受心脏外科手术的老年人死亡率、功能状态或主要不良心脑血管事件（MACCE）的证据。MEDLINE和EMBASE（无语言限制），从其成立到2016年5月2日。在接受重大或微创心脏外科手术的年龄≥60岁患者中评价≥6个月时虚弱与死亡率或功能状态相关性的队列研究。两名评审员独立提取研究数据并评估研究质量。在这两种类型的手术中，活动性、残疾和营养经常被评估为脆弱的领域。在接受大手术的患者中（N=18388，8项研究），评价了9种脆弱手术工具。有中等质量的证据来评估活动性或残疾，极低至低质量的证据使用多组分工具来预测死亡率或MACCE。没有研究检查功能状态。在接受微创手术的患者中（N=5177，17项研究），对13种脆弱手术工具进行了评价。有中到高质量的证据来评估移动性，以预测死亡率或功能状态。几种多组分工具预测死亡率、功能状态或MACCE，但证据质量为低至中等。测量不同脆弱领域的多组分仪器似乎优于单组分仪器。脆弱性评估的异质性，多组分脆弱性工具的普遍性有限，经验证的脆弱性工具很少，以及潜在的出版偏倚。通过活动性、残疾和营养状况评估的虚弱状态可以预测重大心脏手术后6个月或更长时间的死亡率和微创心脏手术后的功能下降。国家老龄化研究所和国家心脏、肺和血液研究所;本综述未注册。
Frailty assessment may inform surgical risk and prognosis that are not captured by conventional surgical risk scores. To evaluate the evidence for various frailty instruments to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCE) in older adults undergoing cardiac surgical procedures. MEDLINE and EMBASE (without language restrictions), from their inception to May 2, 2016. Cohort studies that evaluated the association of frailty with mortality or functional status at ≥6 months in patients aged ≥60 years undergoing major or minimally invasive cardiac surgical procedures. Two reviewers independently extracted study data and assessed study quality. Mobility, disability, and nutrition were frequently assessed domains of frailty in both types of procedures. In patients undergoing major procedures (N=18388, 8 studies), 9 frailty instruments were evaluated. There was moderate-quality evidence to assess mobility or disability and very-low-to-low-quality evidence to use a multi-component instrument to predict mortality or MACCE. No studies examined functional status. In patients undergoing minimally invasive procedures (N=5177, 17 studies), 13 frailty instruments were evaluated. There was moderate-to-high-quality evidence to assess mobility to predict mortality or functional status. Several multi-component instruments predicted mortality, functional status, or MACCE, but the quality of evidence was low to moderate. Multi-component instruments that measure different frailty domains seemed to outperform single-component instruments. Heterogeneity of frailty assessment, limited generalizability of multi-component frailty instruments, few validated frailty instruments, and potential publication bias. Frailty status, assessed by mobility, disability, and nutritional status, can predict mortality at 6 months or later after major cardiac surgical procedures and functional decline after minimally invasive cardiac surgical procedures. National Institute on Aging and National Heart, Lung, and Blood Institute; there was no registration for this review.