From the Department of Anesthesiology & Pain Medicine.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Anesth Analg. 2021 Nov 1;133(5):1094-1106. doi: 10.1213/ANE.0000000000005595.
Frailty is a strong predictor of adverse outcomes in the perioperative period. Given the increasing availability of electronic medical data, we performed a systematic review and meta-analysis with primary objectives of describing available frailty instruments applied to electronic data and synthesizing their prognostic value. Our secondary objectives were to assess the construct validity of frailty instruments that have been applied to perioperative electronic data and the feasibility of electronic frailty assessment.
Following protocol registration, a peer-reviewed search strategy was applied to Medline, Excerpta Medica dataBASE (EMBASE), Cochrane databases, and the Comprehensive Index to Nursing and Allied Health literature from inception to December 31, 2019. All stages of the review were completed in duplicate. The primary outcome was mortality; secondary outcomes included nonhome discharge, health care costs, and length of stay. Effect estimates adjusted for baseline illness, sex, age, procedure, and urgency were of primary interest; unadjusted and adjusted estimates were pooled using random-effects models where appropriate or narratively synthesized. Risk of bias was assessed.
Ninety studies were included; 83 contributed to the meta-analysis. Frailty was defined using 22 different instruments. In adjusted data, frailty identified from electronic data using any instrument was associated with a 3.57-fold increase in the odds of mortality (95% confidence interval [CI], 2.68-4.75), increased odds of institutional discharge (odds ratio [OR], 2.40; 95% CI, 1.99-2.89), and increased costs (ratio of means, 1.54; 95% CI, 1.46-1.63). Most instruments were not multidimensional, head-to-head comparisons were lacking, and no feasibility data were reported.
Frailty status derived from electronic data provides prognostic value as it is associated with adverse outcomes, even after adjustment for typical risk factors. However, future research is required to evaluate multidimensional instruments and their head-to-head performance and to assess their feasibility and clinical impact.
衰弱是围手术期不良结局的强有力预测因素。鉴于电子病历数据的可用性不断增加，我们进行了一项系统评价和荟萃分析，主要目的是描述应用于电子数据的现有衰弱工具，并综合评估其预后价值。我们的次要目标是评估已应用于围手术期电子数据的衰弱工具的结构效度，以及电子衰弱评估的可行性。
在方案注册后，我们采用同行评议的检索策略，检索了从开始到 2019 年 12 月 31 日的 Medline、Excerpta Medica dataBASE（EMBASE）、Cochrane 数据库和 Comprehensive Index to Nursing and Allied Health literature。所有阶段的审查均由两人独立完成。主要结局为死亡率；次要结局包括非家庭出院、医疗费用和住院时间。主要关注的是调整基线疾病、性别、年龄、手术和紧迫性后的效应估计值；在适当情况下，使用随机效应模型汇总调整和未调整的估计值，或者进行叙述性综合。评估了偏倚风险。
共纳入 90 项研究，其中 83 项研究纳入荟萃分析。衰弱使用 22 种不同的工具进行定义。在调整后的数据中，使用任何仪器从电子数据中识别出的衰弱与死亡率增加 3.57 倍相关（95%置信区间[CI]，2.68-4.75），机构出院的几率增加（优势比[OR]，2.40；95% CI，1.99-2.89），以及成本增加（均数比，1.54；95% CI，1.46-1.63）。大多数仪器不是多维的，缺乏头对头比较，也没有报告可行性数据。
从电子数据中得出的衰弱状态提供了预后价值，因为它与不良结局相关，即使在调整了典型的危险因素后也是如此。然而，需要进一步的研究来评估多维工具及其头对头表现，并评估其可行性和临床影响。
