Cardiac surgery as a stressor and the response of the vulnerable older adult
Cardiac surgery as a stressor and the response of the vulnerable older adult
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DOI：
10.1016/j.exger.2016.04.019
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发表时间：
2017-01-01
影响因子：
3.9
通讯作者：
Rudolph, James L.
中科院分区：
文献类型：
--
作者：
Neupane, Iva;Arora, Rakesh C.;Rudolph, James L.
在人口老龄化的情况下，恢复和恢复功能对保持独立至关重要。在过去的50年里，心脏手术过程和结果有了显著的改善，允许在越来越多的老年人群中进行手术，以改善功能。虽然功能改善是可能的，但主要的外科手术与巨大的压力有关，这可能严重影响结果。过去的文献已经确定，易受手术压力影响的虚弱患者更有可能发生术后主要不良心脑血管事件（OR 4.9，95%置信区间1.6，14.6）。这篇文章的目的是通过心脏手术来诱发压力，来检查术前在生物、心理和社会领域的脆弱性。我们系统地检索了PubMed，除了生物学、心理学和社会学关键词外，还包括“心脏手术、虚弱和衰老”。在生物学领域，我们研究了生理和物理脆弱性的关联，以及合并症和炎症对负面手术结果的影响。在心理领域，研究了认知障碍、抑郁和焦虑作为脆弱性的影响。在社会领域，社会结构，应对，差距和成瘾的脆弱性进行了描述。重要的是，在脆弱性领域存在大量重叠。虽然脆弱性研究主要集中在离散的身体脆弱性标准上，但对脆弱性的更广泛定义表明，生物，心理和社会领域的脆弱性可能会限制心脏手术后的恢复。识别这些领域的脆弱性可以更好地了解心脏手术的风险，并定制干预措施以改善结果。
In an aging population, recovery and restoration of function are critical to maintaining independence. Over the past 50 years, there have been dramatic improvements made in cardiac surgery processes and outcomes that allow for procedures to be performed on an increasingly older population with the goal of improving function. Although improved function is possible, major surgical procedures are associated with substantial stress, which can severely impact outcomes. Past literature has identified that frail patients, who are vulnerable to the stress of surgery, are more likely to have postoperative major adverse cardiac and cerebrovascular events (OR 4.9, 95% confidence interval 1.6, 14.6). The objective of this manuscript is to examine preoperative frailty in biological, psychological, and social domains using cardiac surgery to induce stress. We systematically searched PubMed for keywords including "cardiac surgery, frailty, and aged" in addition to the biological, psychological, and social keywords. In the biological domain, we examine the association of physiological and physical vulnerabilities, as well as, the impact of comorbidities and inflammation on negative surgical outcomes. In the psychological domain, the impact of cognitive impairment, depression, and anxiety as vulnerabilities were examined. In the social domain, social structure, coping, disparities, and addiction as vulnerabilities are described. Importantly, there is substantial overlap in the domains of vulnerability. While frailty research has largely focused on discrete physical vulnerability criteria, a broader definition of frailty demonstrates that vulnerabilities in biological, psychological, and social domains can limit recovery after the stress of cardiac surgery. Identification of vulnerability in these domains can allow better understanding of the risks of cardiac surgery and tailoring of interventions to improve outcomes.