Dipartimento di Scienze Dell'Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.
Università Cattolica del Sacro Cuore, Roma, Italia.
BJU Int. 2021 May;127(5):507-517. doi: 10.1111/bju.15314. Epub 2021 Jan 5.
A common limit of the widely used risk scores for preoperative assessment is the lack of information about aspects linked to frailty that may affect outcome, especially in the setting of elderly patients undergoing urological surgery. Frailty has recently been introduced as an additional characteristic to be assessed for better identifying patients at risk of negative outcomes.
To examine the evidence for recent advances in preoperative assessment in patients undergoing urological surgery focussing on the detrimental effect of frailty on outcome, including major (mPCs) and total postoperative complications (tPCs), discharge to a facility, and mortality. The secondary aim was to establish which cut-off scores of the modified Frailty Index (mFI, 11 items) and/or simplified FI (sFI, five items) predicted PCs.
We searched PubMed, the Excerpta Medica database (EMBASE), Cochrane Library and clinicaltrial.gov from inception to 31 May 2020. Studies reporting relationships between the investigated outcomes and patients' frailty were included. We estimated odds ratios (ORs) through a random effect model by using Revman 5.4.
Frailty, assessed by different tools, was associated with a significantly higher rate of 30-day (OR 1.73, 95% confidence interval [CI] 1.58-1.89) and 90-day (OR 2.09, 95% CI 1.14-3.82) mPCs and 30-day tPCs (OR 2.10, 95% CI 1.76-2.52). A mFI of ≥2 was associated with a higher rate of 30-day mPCs (OR 1.79, 95% CI 1.69-1.89) and greater 30-day mortality (OR 3.46, 95% CI 2.10-5.49). A pre-planned post hoc analysis also revealed that a sFI of ≥3 was predictive of mPCs (OR 3.30, 95% CI 2.12-5.12).
Frailty assessment may help to predict PCs and mortality in patients undergoing major urological surgery. Either a mFi of ≥2 or sFI of ≥3 should be considered potential 'red flags' for preoperative risk assessment and decision-making. There is not enough evidence to confirm the necessity to perform frailty assessment in minor urological surgery.
术前评估中广泛使用的风险评分的一个常见局限性是缺乏与虚弱相关的信息，这些信息可能会影响结果，尤其是在接受泌尿科手术的老年患者中。虚弱最近被引入作为评估的附加特征，以更好地识别有发生不良结果风险的患者。
检查最近在接受泌尿科手术的患者术前评估方面的进展情况，重点关注虚弱对结局的不利影响，包括主要（mPCs）和总术后并发症（tPCs）、出院至医疗机构和死亡率。次要目的是确定改良虚弱指数（mFI，11 项）和/或简化 FI（sFI，5 项）的哪个截断评分可以预测 PCs。
我们从建库至 2020 年 5 月 31 日在 PubMed、Excerpta Medica 数据库（EMBASE）、Cochrane 图书馆和 clinicaltrial.gov 中进行了检索。纳入了报告调查结果与患者虚弱之间关系的研究。我们通过使用 Revman 5.4 采用随机效应模型估计了比值比（OR）。
不同工具评估的虚弱与 30 天（OR 1.73，95%置信区间 [CI] 1.58-1.89）和 90 天（OR 2.09，95%CI 1.14-3.82）mPCs 和 30 天 tPCs 的更高发生率显著相关。mFI≥2 与 30 天 mPCs 的更高发生率（OR 1.79，95%CI 1.69-1.89）和更高的 30 天死亡率（OR 3.46，95%CI 2.10-5.49）相关。一项预先计划的事后分析还表明，sFI≥3 可预测 mPCs（OR 3.30，95%CI 2.12-5.12）。
虚弱评估可帮助预测接受主要泌尿科手术的患者的 PCs 和死亡率。mFI≥2 或 sFI≥3 均应被视为术前风险评估和决策的潜在“危险信号”。没有足够的证据证实有必要对小型泌尿科手术进行虚弱评估。
