Department of Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands; Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
J Vasc Surg. 2020 Jan;71(1):297-306.e1. doi: 10.1016/j.jvs.2018.12.060. Epub 2019 Jul 19.
Frailty has been associated with postoperative complications and mortality across surgical specialties, including vascular surgery. However, the influence of frailty on postoperative functional outcomes is unclear. We sought to determine the influence of frailty on functional outcomes after open or endovascular vascular procedures in patients with peripheral arterial disease.
This systematic review was conducted according to the PRISMA guidelines. Eligible articles were identified through database searches of Pubmed and EMBASE in April 2017. Studies reporting on frailty and functional outcomes after vascular interventions for peripheral artery disease (PAD) were included. Outcomes of interest were dependency in activities of daily living (ADL), dependent mobility, discharge destination, disability-free survival, and quality of life. Individual studies were assessed for quality and risk of bias using the Quality in Prognosis Studies tool.
Eight studies met the eligibility criteria and were included. The risk of bias was low in two studies, intermediate in three studies, and high in three studies. Methods for frailty assessment were different for each study. Frailty was a predictor for discharge to a higher level of care, dependent mobility, and dependency in ADL after vascular procedures for PAD. Both frailty models and individual frailty characteristics seem to be associated with these adverse functional outcomes.
Despite a limited amount of literature and an overall intermediate quality of the included studies, this systematic review shows an association between frailty and adverse functional outcomes after peripheral arterial procedures for PAD, including discharge to a care facility, dependent mobility, and a decline in ADL functioning.
衰弱与包括血管外科在内的多个外科专业的术后并发症和死亡率相关。然而，衰弱对术后功能结局的影响尚不清楚。我们旨在确定衰弱对周围动脉疾病患者开放或血管内血管手术后功能结局的影响。
本系统评价按照 PRISMA 指南进行。2017 年 4 月，通过对 Pubmed 和 EMBASE 数据库的检索，确定了合格的文章。纳入报告周围动脉疾病（PAD）血管干预后衰弱和功能结局的研究。感兴趣的结局包括日常生活活动（ADL）依赖、依赖移动、出院去向、无残疾生存和生活质量。使用预后研究质量工具评估个别研究的质量和偏倚风险。
有 8 项研究符合入选标准。两项研究的偏倚风险低，三项研究的偏倚风险中等，三项研究的偏倚风险高。每项研究的衰弱评估方法均不同。衰弱是 PAD 血管手术后更高水平护理、依赖移动和 ADL 依赖的出院的预测因素。衰弱模型和个体衰弱特征都与这些不良功能结局相关。
尽管文献数量有限，且纳入研究的总体质量中等，但本系统评价显示，衰弱与 PAD 周围动脉手术后的不良功能结局相关，包括入住护理机构、依赖移动和 ADL 功能下降。
