Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, Aotearoa New Zealand.
Department of Statistics, The University of Auckland, Auckland, Aotearoa New Zealand.
BJS Open. 2024 Jul 2;8(4). doi: 10.1093/bjsopen/zrae078.
Emergency laparotomy has high morbidity and mortality rates. Frailty assessment remains underutilized in this setting, in part due to time constraints and feasibility. The Clinical Frailty Scale has been identified as the most appropriate tool for frailty assessment in emergency laparotomy patients and is recommended for all older patients undergoing emergency laparotomy. The prognostic impact of measured frailty using the Clinical Frailty Scale on short- and long-term mortality and morbidity rates remains to be determined.
Observational cohort studies were identified by systematically searching Medline, Embase, Scopus and CENTRAL databases up to February 2024, comparing outcomes following emergency laparotomy for frail and non-frail participants defined according to the Clinical Frailty Scale. The primary outcomes were short- and long-term mortality rates. A random-effects model was created with pooling of effect estimates and a separate narrative synthesis was created. Risk of bias was assessed.
Twelve articles comprising 5704 patients were included. Frailty prevalence was 25% in all patients and 32% in older adults (age ≥55 years). Older patients with frailty had a significantly greater risk of postoperative death (30-day mortality rate OR 3.84, 95% c.i. 2.90 to 5.09, 1-year mortality rate OR 3.03, 95% c.i. 2.17 to 4.23). Meta-regression revealed that variations in cut-off values to define frailty did not significantly affect the association with frailty and 30-day mortality rate. Frailty was associated with higher rates of major complications (OR 1.93, 95% c.i. 1.27 to 2.93) and discharge to an increased level of care.
Frailty is significantly correlated with short- and long-term mortality rates following emergency laparotomy, as well as an adverse morbidity rate and functional outcomes. Identifying frailty using the Clinical Frailty Scale may aid in patient-centred decision-making and implementation of tailored care strategies for these 'high-risk' patients, with the aim of reducing adverse outcomes following emergency laparotomy.
急诊剖腹手术具有较高的发病率和死亡率。虚弱评估在这种情况下仍未得到充分利用，部分原因是时间限制和可行性。临床虚弱量表已被确定为评估急诊剖腹手术患者虚弱的最合适工具，并建议所有接受急诊剖腹手术的老年患者使用。使用临床虚弱量表测量的虚弱程度对短期和长期死亡率和发病率的预后影响仍有待确定。
通过系统搜索 Medline、Embase、Scopus 和 CENTRAL 数据库，确定观察性队列研究，检索时间截至 2024 年 2 月，比较根据临床虚弱量表定义的虚弱和非虚弱参与者接受急诊剖腹手术后的结果。主要结局是短期和长期死亡率。使用效应估计值的随机效应模型进行创建，并创建单独的叙述性综合。评估了偏倚风险。
纳入了 12 篇文章，共 5704 名患者。所有患者的虚弱发生率为 25%，年龄较大（年龄≥55 岁）患者的虚弱发生率为 32%。虚弱的老年患者术后死亡风险显著增加（30 天死亡率 OR 3.84，95%置信区间 2.90 至 5.09，1 年死亡率 OR 3.03，95%置信区间 2.17 至 4.23）。元回归显示，定义虚弱的截断值的变化不会显著影响虚弱与 30 天死亡率之间的关联。虚弱与更高的主要并发症发生率（OR 1.93，95%置信区间 1.27 至 2.93）和向更高水平的护理机构出院相关。
虚弱与急诊剖腹手术后的短期和长期死亡率以及不良发病率和功能结局显著相关。使用临床虚弱量表识别虚弱可以帮助以患者为中心进行决策，并为这些“高风险”患者实施量身定制的护理策略，以降低急诊剖腹手术后的不良结局。
