Research Foundation Flanders - FWO, Brussels.
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Curr Opin Anaesthesiol. 2020 Feb;33(1):114-121. doi: 10.1097/ACO.0000000000000815.
To determine the impact of geriatric co-management programmes on outcomes in older patients undergoing a surgical procedure.
Twelve programmes were identified. Time to surgery was decreased in two of four studies [pooled mean difference = -0.7 h (95% CI, -3.1 to 4.4)]. The incidence of complications was reduced in two of seven studies (pooled absolute risk reduction = -4% (95% CI -10 to 2%)). Length of stay was reduced in four of eight studies [pooled mean difference = -1.4 days (95% CI -2.7 to -0.1)]. In-hospital mortality was reduced in one of six studies [pooled absolute risk reduction = -2% (95% CI -4 to -0%)]. Unplanned hospital readmissions at 30 days follow-up was reduced in two of three studies [pooled absolute risk reduction = -3% (95% CI -5 to -0%)].
There was a shorter length of stay, less mortality and a lower readmission rate. However, there was uncertainty whether the results are clinically relevant and the GRADE of evidence was low. It was uncertain whether the outcomes time to surgery and complications were improved. The evidence is limited to hip fracture patients.
确定老年共管理方案对接受手术的老年患者结局的影响。
确定了 12 个方案。4 项研究中的 2 项研究表明手术时间缩短[汇总平均差异=-0.7 小时（95%置信区间，-3.1 至 4.4）]。7 项研究中的 2 项研究表明并发症发生率降低[汇总绝对风险降低=-4%（95%置信区间-10 至 2%）]。8 项研究中的 4 项研究表明住院时间缩短[汇总平均差异=-1.4 天（95%置信区间-2.7 至-0.1）]。6 项研究中的 1 项研究表明院内死亡率降低[汇总绝对风险降低=-2%（95%置信区间-4 至-0%）]。30 天随访时未计划的医院再入院率在 3 项研究中的 2 项研究中降低[汇总绝对风险降低=-3%（95%置信区间-5 至-0%）]。
住院时间更短、死亡率更低、再入院率更低。然而，结果是否具有临床意义尚不确定，证据的 GRADE 等级较低。不确定手术时间和并发症的结局是否得到改善。证据仅限于髋部骨折患者。
