Abdullahi Yusuf S, Athanasopoulos Leonidas V, Casula Roberto P, Moscarelli Marco, Bagnall Mark, Ashrafian Hutan, Athanasiou Thanos
Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
GVM Care & Research Unit, Anthea Hospital, Bari, Italy.
Interact Cardiovasc Thorac Surg. 2017 Apr 1;24(4):619-624. doi: 10.1093/icvts/ivw374.
Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery.
Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included. The focus was on the predictive ability of frailty in this population and a comparison with conventional risk scoring systems. Unfortunately, the lack of a significant number of studies with the same postoperative outcome precluded a formal meta-analysis.
Of 783 studies identified in our initial search, 6 fulfilled our inclusion criteria. Frailty was identified as a predictor of mortality, morbidity and/or prolonged hospital stay in patients undergoing cardiac surgery. Our systematic review revealed the increased application of frailty scores compared to standardized risk stratification scores in cardiothoracic patients. In approximately 50% of these studies, frailty scores continued to be predictive even after adjusting for the conventional risk scoring systems.
The assessment of frailty may enhance the preoperative workup and offer an optimized risk stratification measure in patients undergoing cardiothoracic procedures even though the reporting standards of calibration and classification measures have been relatively poor.
患者虚弱日益被认为是导致心胸外科手术后不良结局的一个因素。本综述的目的是评估虚弱评分系统的预测能力及其在心脏手术患者风险评估中的局限性。
通过检索电子数据库来确定虚弱相关研究。纳入那些测量工具被定义为聚焦于心脏手术人群的多维工具的研究。重点在于虚弱在该人群中的预测能力以及与传统风险评分系统的比较。遗憾的是，由于缺乏大量具有相同术后结局的研究，无法进行正式的荟萃分析。
在我们最初检索到的783项研究中，有6项符合我们的纳入标准。虚弱被确定为心脏手术患者死亡率、发病率和/或住院时间延长的一个预测因素。我们的系统综述显示，与标准化风险分层评分相比，虚弱评分在心胸外科患者中的应用有所增加。在大约50%的这些研究中，即使在调整了传统风险评分系统后，虚弱评分仍具有预测性。
虚弱评估可能会加强术前检查，并为接受心胸手术的患者提供一种优化的风险分层措施，尽管校准和分类措施的报告标准相对较差。
