Kim Sunghye, Duncan Pamela W, Groban Leanne, Segal Hannah, Abbott Rica Moonyeen, Williamson Jeff D
Department of Internal Medicine, Winston-Salem, NC, USA.
Sticht Center on Aging, Winston-Salem, NC, USA.
J Anesth Perioper Med. 2017 Nov 28;4(6):274-281. Epub 2017 Nov 2.
Patient-reported outcomes (PRO) on functional, social, and behavioral factors might be important preoperative predictors of postoperative outcomes. We conducted a literature review to explore associations of preoperative depression, socioeconomic status, social support, functional status/frailty, cognitive status, self-management skills, health literacy, and nutritional status with surgical outcomes.
Two electronic data bases, including PubMed and Google Scholar, were searched linking either depression, socioeconomic status, social support, functional status/frailty, cognitive status, self-management skills, health literacy, or nutritional status with surgery, postoperative complications, or perioperative period within the past 2 decades.
Preoperative depression has been linked to postoperative delirium, complications, persistent pain, longer lengths of stay, and mortality. Socioeconomic status associates with overall and cancer-free survival. Low socioeconomic status has also been connected to medication non- compliance. Social support can predict overall and cancer- free survival, as well as physical, social and emotional quality of life. Poor functional status and frailty have been related to postoperative complications, longer lengths of stay, post-discharge institutionalization, and higher costs. Preoperative cognitive impairment also associates with self-medication management errors, postoperative cognitive impairment, delirium, complications and mortality. In addition, a greater tendency for reduced adherence to preoperative medication instructions has been linked to health illiteracy. Preoperative malnutrition is prevalent and associates with postoperative morbidity.
Efficient and effective assessments of social and behavioral determinants of health, functional status, health literacy, patient's perception of health, and preferences for self-management may improve postoperative management and surgical outcomes, particularly among vulnerable patients undergoing elective surgery who might have subtle physical, social, or psychological deficits or challenges, otherwise missed upon routine evaluation. Patient Reported Outcome Measures (PROMs) can be used to effectively and efficiently collect these factors in the preoperative period, thereby identifying areas that can be intervened preemptively. (Partially Funded by the National Institute on Aging and the Wake Forest University Claude D. Pepper Older Americans Independence Center.).
患者报告的关于功能、社会和行为因素的结果可能是术后结果的重要术前预测指标。我们进行了一项文献综述，以探讨术前抑郁、社会经济地位、社会支持、功能状态/虚弱、认知状态、自我管理技能、健康素养和营养状况与手术结果之间的关联。
检索了两个电子数据库，包括PubMed和谷歌学术，搜索在过去20年内将抑郁、社会经济地位、社会支持、功能状态/虚弱、认知状态、自我管理技能、健康素养或营养状况与手术、术后并发症或围手术期联系起来的文献。
术前抑郁与术后谵妄、并发症、持续性疼痛、住院时间延长和死亡率相关。社会经济地位与总体生存率和无癌生存率相关。低社会经济地位还与药物治疗不依从有关。社会支持可以预测总体生存率和无癌生存率，以及身体、社会和情感生活质量。功能状态差和虚弱与术后并发症、住院时间延长、出院后入住机构以及更高的费用相关。术前认知障碍还与自我用药管理错误、术后认知障碍、谵妄、并发症和死亡率相关。此外，对术前用药说明依从性降低的更大倾向与健康素养低有关。术前营养不良很普遍，与术后发病率相关。
对健康的社会和行为决定因素、功能状态、健康素养、患者对健康的认知以及自我管理偏好进行高效且有效的评估，可能会改善术后管理和手术结果，尤其是在接受择期手术的脆弱患者中，这些患者可能存在细微的身体、社会或心理缺陷或挑战，而在常规评估中可能会被遗漏。患者报告结局测量（PROMs）可用于在术前有效且高效地收集这些因素，从而确定可以提前进行干预的领域。（部分由美国国立衰老研究所和维克森林大学克劳德·D·佩珀老年美国人独立中心资助。）
