Department of Neurosurgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine Haikou, China.
Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Biosci Trends. 2023 Sep 15;17(4):271-282. doi: 10.5582/bst.2023.01208. Epub 2023 Aug 25.
With the rapid increase in global aging, the prevalence of frailty is increasing and frailty has emerged as an emerging public health burden. Frail elderly patients suffer from reduced homeostatic reserve capacity, which is associated with a disproportionate decline in physical status after exposure to stress and an increased risk of adverse events. Frailty is closely associated with changes in the volume of the white and gray matter of the brain. Sarcopenia has been suggested to be an important component of frailty, and reductions in muscle strength and muscle mass lead to reductions in physical function and independence, which are critical factors contributing to poor prognosis. Approximately 10-32% of patients undergoing neurological surgery are frail, and the risk of frailty increases with age, which is significantly associated with the occurrence of adverse postoperative events (major complications, total duration of hospitalization, and need for discharge to a nursing facility). The postoperative mortality rate in severely frail patients is 9-11 times higher than that in non-frail individuals. Therefore, due attention must be paid to neurosurgical frailty and muscle assessment in elderly patients. Specialized interventions in the perioperative period of neurosurgery in frail elderly patients may improve their postoperative prognosis.
随着全球老龄化的迅速增加，衰弱的患病率正在增加，衰弱已成为新的公共卫生负担。虚弱的老年患者的体内平衡储备能力降低，这与在压力下身体状况不成比例下降以及不良事件风险增加有关。衰弱与大脑白质和灰质体积的变化密切相关。有人认为肌少症是衰弱的一个重要组成部分，肌肉力量和肌肉质量的减少导致身体功能和独立性下降，这是导致预后不良的关键因素。大约有 10-32%接受神经外科手术的患者身体虚弱，并且虚弱的风险随着年龄的增长而增加，这与不良术后事件（主要并发症、总住院时间和需要出院到护理机构）的发生显著相关。严重虚弱患者的术后死亡率是身体非虚弱患者的 9-11 倍。因此，必须重视老年患者的神经外科虚弱和肌肉评估。对虚弱老年患者神经外科围手术期进行专门干预可能会改善他们的术后预后。
