Watt Jennifer, Tricco Andrea C, Talbot-Hamon Catherine, Pham Ba', Rios Patricia, Grudniewicz Agnes, Wong Camilla, Sinclair Douglas, Straus Sharon E
Division of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada.
Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, Ontario, M5T 3M6, Canada.
BMC Med. 2018 Jan 12;16(1):2. doi: 10.1186/s12916-017-0986-2.
Elective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery.
Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Prospective studies reporting prognostic factors associated with postoperative complications (composite outcome of medical and surgical complications), functional decline, mortality, post-hospitalization discharge destination, and prolonged hospitalization among older adults undergoing elective surgery were included. Study characteristics and prognostic factors associated with the outcomes of interest were extracted independently by two reviewers. Random effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidences of adverse outcomes.
Of the 5692 titles and abstracts that were screened for inclusion, 44 studies (12,281 patients) reported on the following adverse postoperative outcomes: postoperative complications (n =28), postoperative mortality (n = 11), length of hospitalization (n = 21), functional decline (n = 6), and destination at discharge from hospital (n = 13). The pooled incidence of postoperative complications was 25.17% (95% confidence interval (CI) 18.03-33.98%, number needed to follow = 4). The geriatric syndromes of frailty (odds ratio (OR) 2.16, 95% CI 1.29-3.62) and cognitive impairment (OR 2.01, 95% CI 1.44-2.81) were associated with developing postoperative complications; however, there was no association with traditionally assessed prognostic factors such as age (OR 1.07, 95% CI 1.00-1.14) or American Society of Anesthesiologists status (OR 2.62, 95% CI 0.78-8.79). Besides frailty, other potentially modifiable prognostic factors, including depressive symptoms (OR 1.77, 95% CI 1.22-2.56) and smoking (OR 2.43, 95% CI 1.32-4.46), were also associated with developing postoperative complications.
Geriatric syndromes are important prognostic factors for postoperative complications. We identified potentially modifiable prognostic factors (e.g., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care.
择期手术可能会对老年人造成严重伤害。本研究旨在确定接受择期手术的老年人术后并发症发生的相关预后因素。
检索了Medline、EMBASE、CINAHL、Cochrane对照试验中央注册库和AgeLine，查找自数据库建立至2016年4月21日发表的文章。纳入前瞻性研究，这些研究报告了接受择期手术的老年人术后并发症（医疗和手术并发症的综合结果）、功能下降、死亡率、出院后去向以及住院时间延长的相关预后因素。两位研究者独立提取与感兴趣的结局相关的研究特征和预后因素。采用随机效应荟萃分析模型得出预后因素和不良结局发生率的合并效应估计值。
在筛选纳入的5692篇标题和摘要中，44项研究（12281例患者）报告了以下术后不良结局：术后并发症（n = 28）、术后死亡率（n = 11）、住院时间（n = 21）、功能下降（n = 6）以及出院去向（n = 13）。术后并发症的合并发生率为25.17%（95%置信区间（CI）18.03 - 33.98%，需随访人数 = 4）。衰弱（比值比（OR）2.16，95% CI 1.29 - 3.62）和认知障碍（OR 2.01，95% CI 1.44 - 2.81）等老年综合征与术后并发症的发生相关；然而，与传统评估的预后因素如年龄（OR 1.07，95% CI 1.00 - 1.14）或美国麻醉医师协会分级（OR 2.62，95% CI 0.78 - 8.79）无关。除衰弱外，其他可能可改变的预后因素，包括抑郁症状（OR 1.77，95% CI 1.22 - 2.56）和吸烟（OR 2.43，95% CI 1.32 - 4.46），也与术后并发症的发生相关。
老年综合征是术后并发症的重要预后因素。我们确定了与术后并发症发生相关的可能可改变的预后因素（如衰弱、抑郁症状和吸烟），术前可针对这些因素优化护理。
