Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
The Centre of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Centre of Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Eur J Vasc Endovasc Surg. 2018 Oct;56(4):591-602. doi: 10.1016/j.ejvs.2018.07.012. Epub 2018 Aug 16.
To evaluate the quality of published evidence of all frailty tools in major vascular surgery and to determine the effect of frailty on short and long-term outcomes after vascular procedures.
MEDLINE, Embase, Cochrane Database and Scopus (updated on May 12, 2018) were searched for studies evaluating the effect of frailty in vascular surgery and data were extracted from the included studies. A modified Newcastle-Ottawa scale was used to assess the quality of the included studies. The impact of frailty on outcomes was expressed as odds ratios (OR) or hazard ratios (HR) using a random effects model.
A total of 22 cohort studies and one RCT were included. Overall frailty was found to be associated with a significantly increased risk of 30 day mortality in patients who underwent vascular surgery (OR 3.83, 95% CI 3.08-4.76), with similar effects in both patients who underwent abdominal aortic aneurysm (AAA) repair (OR 5.15, 95% CI 3.91-6.77) and lower extremity revascularisation (OR 3.29, 95% CI 2.53-4.28). Functional status remained the only tool with high quality of evidence predicting 30 day mortality after vascular surgery (OR 4.49, 95% CI 3.81-5.30). As for long-term outcomes, frailty was associated with a significantly increased risk of long-term all cause mortality in the overall studied population (HR 2.22, 95% CI 1.81-2.73), as well as in patients with AAA repair (HR 2.10, 95% CI 1.59-2.79) and lower extremity revascularisation (HR 2.46, 95% CI 1.73-3.49). Central muscle mass was found to be the only tool with moderate quality of evidence predicting long-term survival after major vascular surgery (HR 2.48, 95% CI 1.76-3.49). Other single domain tools were generally scored as low quality, and the modified Frailty Index was the only multi-domain tool with moderate quality while others were scored as low or very low.
Frailty, assessed by functional status, can predict short-term mortality in elderly patients after vascular surgery; while central muscle mass may help determine long-term survival in abdominal aortic repair. As frailty is associated with both worse short and long-term outcomes, frailty assessment may be considered in patients scheduled for vascular surgery.
评估主要血管外科中所有虚弱工具的发表证据质量，并确定虚弱对血管手术后短期和长期结局的影响。
检索 MEDLINE、Embase、Cochrane 数据库和 Scopus（更新于 2018 年 5 月 12 日），以评估血管外科中虚弱的影响，并从纳入的研究中提取数据。使用改良的 Newcastle-Ottawa 量表评估纳入研究的质量。使用随机效应模型表示虚弱对结局的影响，结果表示为比值比（OR）或风险比（HR）。
共纳入 22 项队列研究和 1 项 RCT。总体而言，虚弱与血管手术后 30 天死亡率显著增加相关（OR 3.83，95%CI 3.08-4.76），在接受腹主动脉瘤（AAA）修复（OR 5.15，95%CI 3.91-6.77）和下肢血运重建（OR 3.29，95%CI 2.53-4.28）的患者中也有类似的影响。功能状态仍然是唯一具有预测血管手术后 30 天死亡率的高质量证据的工具（OR 4.49，95%CI 3.81-5.30）。对于长期结局，虚弱与研究人群的长期全因死亡率显著增加相关（HR 2.22，95%CI 1.81-2.73），以及 AAA 修复（HR 2.10，95%CI 1.59-2.79）和下肢血运重建（HR 2.46，95%CI 1.73-3.49）患者。中央肌肉质量被发现是唯一具有中等质量证据的工具，可以预测主要血管手术后的长期生存（HR 2.48，95%CI 1.76-3.49）。其他单域工具通常被评为低质量，改良的虚弱指数是唯一具有中等质量的多域工具，而其他工具则被评为低质量或极低质量。
通过功能状态评估的虚弱可以预测血管手术后老年患者的短期死亡率；而中央肌肉质量可能有助于确定腹主动脉修复的长期生存。由于虚弱与短期和长期结局均较差相关，因此在计划进行血管手术的患者中可考虑进行虚弱评估。
