血管手术和截肢患者的衰弱评分与预后：一项系统评价和荟萃分析。
Frailty score and outcomes of patients undergoing vascular surgery and amputation: A systematic review and meta-analysis.
作者信息
Chen Shujie, Dunn Riley, Jackson Mark, Morley Nicola, Sun Jing
机构信息
School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.
School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia.
出版信息
Front Cardiovasc Med. 2023 Jan 25;10:1065779. doi: 10.3389/fcvm.2023.1065779. eCollection 2023.
INTRODUCTION
Frailty is associated with adverse postoperative health outcomes, including increased mortality, longer length of stay, higher rehospitalization, and other complications. There are many frailty assessment tools are to assess the level of frailty in vascular surgery patients. The aim of this study was to perform a systematic review and meta-analysis to assess the association between the frailty levels described by different frailty scores and adverse postoperative health outcomes among hospitalized vascular surgery patients and patients undergoing amputation.
METHODS
Studies utilizing frailty scores and similar frailty assessment tools to describe frailty and investigate the association between frailty and health outcomes were searched. The primary outcomes of this study were in-hospital mortality, postdischarge mortality, length of hospital stay, rehospitalization, and discharge location. Additional outcomes included postoperative myocardial infarction, postoperative renal failure, cerebrovascular accident and stroke, comorbidities, and estimated glomerular filtration rate (eGFR) levels. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for quality assessment.
RESULTS
In total, 24 studies with 1,886,611 participants were included in the final analysis. The overall results found that higher in-hospital mortality and postdischarge mortality were significantly associated with frailty. Frailty was also found to be significantly associated with a longer length of hospital stay, higher rehospitalization, and higher likelihood of non-home discharge. In addition, the results also showed that frailty was significantly associated with all kinds of comorbidities investigated, except chronic kidney disease. However, lower eGFR levels were significantly associated with frailty.
CONCLUSION
Among patients who underwent all types of vascular surgery and those who underwent amputations, assessment of frailty was significantly associated with adverse postoperative outcomes and multiple comorbidities.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=336374, identifier CRD42022336374.
引言
衰弱与术后不良健康结局相关，包括死亡率增加、住院时间延长、再住院率升高及其他并发症。有许多衰弱评估工具可用于评估血管外科患者的衰弱程度。本研究的目的是进行系统评价和荟萃分析，以评估不同衰弱评分所描述的衰弱水平与住院血管外科患者及截肢患者术后不良健康结局之间的关联。
方法
检索了利用衰弱评分及类似衰弱评估工具来描述衰弱并调查衰弱与健康结局之间关联的研究。本研究的主要结局为住院死亡率、出院后死亡率、住院时间、再住院率及出院地点。其他结局包括术后心肌梗死、术后肾衰竭、脑血管意外和中风、合并症及估计肾小球滤过率（eGFR）水平。采用乔安娜·布里格斯研究所（JBI）批判性评价工具进行质量评估。
结果
最终分析共纳入24项研究，1,886,611名参与者。总体结果发现，较高的住院死亡率和出院后死亡率与衰弱显著相关。还发现衰弱与住院时间延长、再住院率升高及非家庭出院的可能性增加显著相关。此外，结果还显示，除慢性肾脏病外，衰弱与所调查的各类合并症均显著相关。然而，较低的eGFR水平与衰弱显著相关。
结论
在接受各类血管手术的患者及接受截肢手术的患者中，衰弱评估与术后不良结局及多种合并症显著相关。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=336374，标识符CRD42022336374。
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