Zhu Jinfeng, Qiu Xichenhui, Ji Cuiling, Wang Fang, Tao An, Chen Lu
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Medical School of Nanjing University, Nanjing, Jiangsu, China.
Front Psychiatry. 2023 Feb 17;14:1126123. doi: 10.3389/fpsyt.2023.1126123. eCollection 2023.
Patients with frailty are at a high risk of poor health outcomes, and frailty has been explored as a predictor of adverse events, such as perioperative complications, readmissions, falls, disability, and mortality in the neurosurgical literature. However, the precise relationship between frailty and neurosurgical outcomes in patients with brain tumor has not been established, and thus evidence-based advancements in neurosurgical management. The objectives of this study are to describe existing evidence and conduct the first systematic review and meta-analysis of the relationship between frailty and neurosurgical outcomes among brain tumor patients.
Seven English databases and four Chinese databases were searched to identify neurosurgical outcomes and the prevalence of frailty among patients with a brain tumor, with no restrictions on the publication period. According to the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, two independent reviewers employed the Newcastle-Ottawa scale in cohort studies and JBI Critical Appraisal Checklist for Cross-sectional Studies to evaluate the methodological quality of each study. Then random-effects or fixed-effects meta-analysis was used in combining odds ratio (OR) or hazard ratio (RR) for the categorical data and continuous data of neurosurgical outcomes. The primary outcomes are mortality and postoperative complications, and secondary outcomes include readmission, discharge disposition, length of stay (LOS), and hospitalization costs.
A total of 13 papers were included in the systematic review, and the prevalence of frailty ranged from 1.48 to 57%. Frailty was significantly associated with increased risk of mortality (OR = 1.63; CI = 1.33-1.98; < 0.001), postoperative complications (OR = 1.48; CI = 1.40-1.55; < 0.001; = 33%), nonroutine discharge disposition to a facility other than home (OR = 1.72; CI = 1.41-2.11; < 0.001), prolonged LOS (OR = 1.25; CI = 1.09-1.43; = 0.001), and high hospitalization costs among brain tumor patients. However, frailty was not independently associated with readmission (OR = 0.99; CI = 0.96-1.03; = 0.74).
Frailty is an independent predictor of mortality, postoperative complications, nonroutine discharge disposition, LOS, and hospitalization costs among brain tumor patients. In addition, frailty plays a significant potential role in risk stratification, preoperative shared decision making, and perioperative management.
PROSPERO CRD42021248424.
虚弱患者健康结局不良风险高，在神经外科文献中，虚弱已被探讨作为不良事件的预测指标，如围手术期并发症、再入院、跌倒、残疾和死亡率。然而，脑肿瘤患者中虚弱与神经外科结局的确切关系尚未确立，因此神经外科管理缺乏循证进展。本研究的目的是描述现有证据，并首次对脑肿瘤患者中虚弱与神经外科结局的关系进行系统评价和荟萃分析。
检索七个英文数据库和四个中文数据库，以确定神经外科结局以及脑肿瘤患者中虚弱的患病率，对发表时间无限制。根据乔安娜·布里格斯研究所（JBI）证据综合手册和系统评价与荟萃分析优先报告项目（PRISMA）指南，两名独立 reviewers 在队列研究中采用纽卡斯尔 - 渥太华量表，在横断面研究中采用 JBI 批判性评价清单来评估每项研究的方法学质量。然后对神经外科结局的分类数据和连续数据使用随机效应或固定效应荟萃分析来合并比值比（OR）或风险比（RR）。主要结局是死亡率和术后并发症，次要结局包括再入院、出院处置、住院时间（LOS）和住院费用。
系统评价共纳入 13 篇论文，虚弱患病率在 1.48%至 57%之间。虚弱与脑肿瘤患者死亡率增加（OR = 1.63；CI = 1.33 - 1.98；P < 0.001）、术后并发症（OR = 1.48；CI = 1.40 - 1.55；P < 0.001；I² = 33%）、非常规出院至家庭以外机构（OR = 1.72；CI = 1.41 - 2.11；P < 0.001）、住院时间延长（OR = 1.25；CI = 1.09 - 1.43；P = 0.001）以及高住院费用显著相关。然而，虚弱与再入院无独立关联（OR = 0.99；CI = 0.96 - 1.03；P = 0.74）。
虚弱是脑肿瘤患者死亡率、术后并发症、非常规出院处置、住院时间和住院费用的独立预测指标。此外，虚弱在风险分层、术前共同决策和围手术期管理中发挥着重要的潜在作用。
PROSPERO CRD42021248424
