General Surgery Department, CDSS University of Turin, Torino, Italy.
Eur J Surg Oncol. 2024 May;50(5):106862. doi: 10.1016/j.ejso.2023.03.002. Epub 2023 Mar 5.
Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature. A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery. This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition. Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative care should include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.
尽管在外科人群中，脆弱性具有明显的临床意义，但即使在老年医学文献中，也没有关于如何最好地定义或衡量脆弱性的共识。存在多种衡量标准来衡量其中的一些或全部领域，但只有专注于研究的工具在外科人群中得到了验证。这些工具对于考虑择期手术的整个人群进行快速、经济高效的术前筛选来说资源过于密集。本叙述性评论涉及脆弱性的定义以及表型定义和缺陷积累定义的不同评估方法。此外，由于在外科领域，脆弱性似乎是死亡率、发病率、住院时间和术后并发症的独立危险因素，因此考虑了不同研究报告的术前脆弱性与癌症手术后的术后结局以及术后 30 天内的术后死亡率之间的相关性。术前护理应侧重于治疗和护理方案的目标。必须进一步研究以患者为导向的功能和认知结果，以及干预措施的制定和实施，这些干预措施可能潜在地改善不良的术后效果。
