Koh Bernard Jqw, Lee Quinncy, Wee Ian Jy, Syn Nicholas, Lee Keng Siang, Jie Ng Jun, Wong Audrey LA, Soong John Ty, Mtl Choong Andrew
SingVaSC, Singapore Vascular Collaborative, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Vasc Med. 2022 Jun;27(3):302-307. doi: 10.1177/1358863X221093400.
One in 10 independently living adults aged 65 years old and older is considered frail, and frailty is associated with poor postoperative outcomes. This systematic review aimed to examine the association between frailty assessments and postoperative outcomes in patients with vascular disease. Electronic databases - MEDLINE, Embase, and the Cochrane Library - were searched from inception until January 2022, resulting in 648 articles reviewed for potential inclusion and 16 studies selected. Demographic data, surgery type, frailty measure, and postoperative outcomes predicted by frailty were extracted from the selected studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. The selected studies (mean age: 56.1-76.3 years) had low-to-moderate risk of bias and included 16 vascular (elective and nonelective) surgeries and eight frailty measures. Significant associations ( < 0.05) were established between mortality (30-day, 90-day, 1-year, 5-year), 30-day morbidity, nonhome discharge, adverse events, failure to rescue, patient requiring care after discharge, and amputation following critical limb ischaemia. The strongest evidence was found between 30-day mortality and frailty. Composite 30-day morbidity and mortality, functional status at discharge, length of stay, spinal cord deficit, and access site complications were found to be nonsignificantly associated with frailty. With frailty being significantly associated with several adverse postoperative outcomes, preoperative frailty assessments can potentially be clinically useful in helping practitioners predict and guide the pre-, peri-, and postoperative management of frail with vascular disease.
每10名65岁及以上独立生活的成年人中就有1人被认为是虚弱的，而且虚弱与术后不良结局相关。本系统评价旨在研究血管疾病患者的虚弱评估与术后结局之间的关联。检索了电子数据库——MEDLINE、Embase和Cochrane图书馆——从创建至2022年1月，共筛选出648篇文章以供潜在纳入，最终选定16项研究。从选定的研究中提取人口统计学数据、手术类型、虚弱测量方法以及由虚弱预测的术后结局。使用纽卡斯尔-渥太华量表评估偏倚风险。选定的研究（平均年龄：56.1 - 76.3岁）偏倚风险为低到中度，包括16项血管（择期和非择期）手术以及8种虚弱测量方法。在死亡率（30天、90天、1年、5年）、30天发病率、非回家出院、不良事件、未能挽救、出院后需要护理的患者以及严重肢体缺血后的截肢之间建立了显著关联（<0.05）。在30天死亡率和虚弱之间发现了最强的证据。发现30天综合发病率和死亡率、出院时的功能状态、住院时间、脊髓缺损和穿刺部位并发症与虚弱无显著关联。由于虚弱与术后的几种不良结局显著相关，术前虚弱评估在帮助医生预测和指导血管疾病虚弱患者的术前、术中和术后管理方面可能具有临床实用性。
