Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L
School of Medicine and Surgery, Milano-Bicocca University Monza Italy.
Department of Surgery San Gerardo Hospital Monza Italy.
BJS Open. 2017 Nov 9;1(5):128-137. doi: 10.1002/bjs5.22. eCollection 2017 Oct.
Frailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long-term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.
An extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random-effects meta-analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long-term mortality. The potential effect of the number of domains of the frailty indices was explored through meta-regression at moderator analysis.
A total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short-term mortality (OR 5·77, 4·41 to 7·55) and long-term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co-morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.
Regardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.
衰弱与预后不良相关，但众多的定义和评估量表使得其对结局的影响难以评估。本研究的目的是量化衰弱对腹部大手术后的术后发病率和死亡率以及长期死亡率的影响，并评估不同衰弱指标的性能。
进行了全面的文献检索，以获取所有调查衰弱是否会影响成年人群择期腹部大手术后结局的原始文章。考虑了所有可能的衰弱定义。对所有感兴趣的结局进行随机效应荟萃分析。对于术后发病率和死亡率，总体效应大小估计为比值比（OR），而长期死亡率则计算风险比（HR）。通过在调节分析中进行荟萃回归，探讨了衰弱指数领域数量的潜在影响。
共分析了35项研究中的1153684例患者。衰弱与术后严重并发症风险显著增加（OR 2.56，95%置信区间2.08至3.16）、短期死亡率（OR 5.77，4.41至7.55）和长期死亡率（HR 2.71，1.63至4.49）相关。所有领域均与术后严重并发症的发生显著相关，合并症的OR为1.09（1.00至1.18），肌肉减少症的OR为2.52（1.32至4.80）。未观察到根据衰弱成分数量的调节效应。
无论领域的定义和组合如何，衰弱与腹部大手术后术后发病率和死亡率增加的风险显著相关。
