虚弱与接受开颅手术患者临床结局的相关性：观察性研究的系统评价和荟萃分析。
Association between frailty and clinical outcomes in patients undergoing craniotomy-systematic review and meta-analysis of observational studies.
机构信息
Victorian Heart Hospital, Melbourne, Victoria, Australia.
Monash Health, Clayton, Australia.
出版信息
Syst Rev. 2024 Feb 23;13(1):73. doi: 10.1186/s13643-024-02479-3.
BACKGROUND
Frailty in patients undergoing craniotomy may affect perioperative outcomes. There have been a number of studies published in this field; however, evidence is yet to be summarized in a quantitative review format. We conducted a systematic review and meta-analysis to examine the effects of frailty on perioperative outcomes in patients undergoing craniotomy surgery.
METHODS
Our eligibility criteria included adult patients undergoing open cranial surgery. We searched MEDLINE via Ovid SP, EMBASE via Ovid SP, Cochrane Library, and grey literature. We included retrospective and prospective observational studies. Our primary outcome was a composite of complications as per the Clavien-Dindo classification system. We utilized a random-effects model of meta-analysis. We conducted three preplanned subgroup analyses: patients undergoing cranial surgery for tumor surgery only, patients undergoing non-tumor surgery, and patients older than 65 undergoing cranial surgery. We explored sources of heterogeneity through a sensitivity analysis and post hoc analysis.
RESULTS
In this review of 63,159 patients, the pooled prevalence of frailty was 46%. The odds ratio of any Clavien-Dindo grade 1-4 complication developing in frail patients compared to non-frail patients was 2.01 [1.90-2.14], with no identifiable heterogeneity and a moderate level of evidence. As per GradePro evidence grading methods, there was low-quality evidence for patients being discharged to a location other than home, length of stay, and increased mortality in frail patients.
CONCLUSION
Increased frailty was associated with increased odds of any Clavien-Dindo 1-4 complication. Frailty measurements may be used as an integral component of risk-assessment strategies to improve the quality and value of neurosurgical care for patients undergoing craniotomy surgery.
ETHICS AND DISSEMINATION
Formal ethical approval is not needed, as primary data were not collected.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO identification number: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=405240.
背景
接受开颅手术的患者的虚弱状况可能会影响围手术期的结果。该领域已经有许多研究发表，但仍需要以定量综述的形式对证据进行总结。我们进行了一项系统回顾和荟萃分析，以检查虚弱对接受开颅手术患者围手术期结果的影响。
方法
我们的纳入标准包括接受开放性颅脑手术的成年患者。我们通过 Ovid SP 搜索 MEDLINE、通过 Ovid SP 搜索 EMBASE、Cochrane 图书馆和灰色文献。我们纳入了回顾性和前瞻性观察性研究。我们的主要结局是根据 Clavien-Dindo 分类系统的并发症综合指标。我们采用了随机效应模型的荟萃分析。我们进行了三个预先计划的亚组分析：仅因肿瘤手术而接受颅手术的患者、因非肿瘤手术而接受颅手术的患者和 65 岁以上接受颅手术的患者。我们通过敏感性分析和事后分析来探索异质性的来源。
结果
在这项对 63159 名患者的综述中，虚弱的总体患病率为 46%。与非虚弱患者相比，虚弱患者出现任何 Clavien-Dindo 1-4 级并发症的优势比为 2.01 [1.90-2.14]，没有可识别的异质性，证据质量为中等。根据 GradePro 证据分级方法，虚弱患者出院到非家庭场所、住院时间延长和死亡率增加的证据质量为低。
结论
虚弱程度增加与任何 Clavien-Dindo 1-4 级并发症的发生几率增加相关。虚弱测量值可作为风险评估策略的一个组成部分，以提高接受开颅手术患者的神经外科护理质量和价值。
伦理和传播
由于没有收集原始数据，因此不需要正式的伦理批准。
系统综述注册
PROSPERO 编号：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=405240。
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