Chang Jaewon, Nathalie Janice, Nguyenhuy Minhtuan, Xu Ruiwen, Virk Sohaib A, Saxena Akshat
The Royal Melbourne Hospital, Parkville, Victoria, Australia.
St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
J Card Surg. 2022 Jan;37(1):197-204. doi: 10.1111/jocs.16089. Epub 2021 Oct 19.
Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients.
PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and "normal" gait speed. Primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay.
There were seven eligible studies with 36,697 patients. Slow gait speed was associated with increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87-2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38-1.66), AKI (RR: 2.81; 95% CI: 1.44-5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59-1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48-2.63), reoperation (RR: 1.38; 95% CI: 1.05-1.82), institutional discharge (RR: 2.08; 95% CI: 1.61-2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32-26.05).
Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than nonfrail counterparts and are at an increased risk of developing various perioperative complications.
衰弱与心脏手术预后较差相关，但衰弱评估工具的异质性使得难以确定其在心脏手术中的真正影响。步态速度慢是一种简单、经过验证且可靠的衰弱标志物。我们进行了一项系统评价和荟萃分析，以研究步态速度慢对心脏手术术后患者的影响。
检索了2000年1月至2021年8月的PubMed、MEDLINE和EMBASE数据库，以查找比较步态速度慢和“正常”步态速度的研究。主要结局是住院死亡率。次要结局包括综合死亡率和主要并发症、急性肾损伤、中风、深部胸骨伤口感染、通气时间延长、转至医疗机构以及重症监护病房住院时间。
有7项符合条件的研究，共36697例患者。步态速度慢与住院死亡率增加相关（风险比[RR]：2.32；95%置信区间[CI]：1.87-2.87）。此外，他们更有可能发生综合死亡率和主要并发症（RR：1.52；95%CI：1.38-1.66）、急性肾损伤（RR：2.81；95%CI：1.44-5.49）、深部胸骨伤口感染（RR：1.77；95%CI：1.59-1.98）、通气时间延长>24小时（RR：1.97；95%CI：1.48-2.63）、再次手术（RR：1.38；95%CI：1.05-1.82）、机构出院（RR：2.08；95%CI：1.61-2.69）以及重症监护病房住院时间更长（MD：21.69；95%CI：17.32-26.05）。
步态速度慢与心脏手术预后较差相关。衰弱患者在住院期间死亡的可能性是非衰弱患者的两倍，并且发生各种围手术期并发症的风险增加。
