Lozada-Martinez Ivan David, Hernandez-Paez David A, Palacios Velasco Isabela, Martinez Guevara Darly, Liscano Yamil
Biomedical Scientometrics and Evidence-Based Research Unit, Department of Health Sciences, Universidad de la Costa, Barranquilla 500366, Colombia.
Center for Meta-Research and Scientometrics in Biomedical Sciences, Barranquilla 500366, Colombia.
J Clin Med. 2024 Sep 13;13(18):5441. doi: 10.3390/jcm13185441.
The world is facing a significant demographic transition, with a substantial increase in the proportion of older persons, as well as long-lived persons (especially nonagenarians and centenarians). One of the popular beliefs is that old age is synonymous with disease and disability. However, the successful aging hypothesis suggests that those older persons with advanced chronological age who maintain their functional capacity derive from it a delay in biological aging, enhancing the quality of organic aging and regulation. Therefore, regardless of chronological age, even in cases of extreme longevity, those older adults with a successful aging phenotype and favorable functional capacity would be expected to have satisfactory post-surgical recovery with a low risk of morbidity and mortality. Currently, there is a significant gap between the availability of high-certainty surgical evidence that allows for evidence-based interventions applicable to the long-lived population-taking into account the actual conditioning factors of the health phenotype in older persons-and, above all, predictors of satisfactory post-surgical evolution. The application of meta-research to geriatric surgery emerges as a fundamental tool to address this knowledge gap and reveals opportunities and limitations that need to be resolved in the near future to establish evidence-based surgical care for older persons. The aim of this manuscript was to present a real and globally relevant scenario related to surgical care, addressing the longevity, the availability, and the quality of surgical evidence applicable to this population, and also to present variables to consider in analysis and future perspectives in research and meta-research in geriatric surgery.
世界正面临重大的人口结构转变，老年人以及长寿者（尤其是九十多岁和百岁老人）的比例大幅增加。一种普遍的观点认为，老年等同于疾病和残疾。然而，成功老龄化假说表明，那些达到较高实际年龄但仍保持功能能力的老年人，其生物衰老过程会延迟，从而提高机体衰老和调节的质量。因此，无论实际年龄如何，即使是在极端长寿的情况下，那些具有成功老龄化表型和良好功能能力的老年人，术后有望获得满意的恢复，发病和死亡风险较低。目前，在可获得的高确定性手术证据方面存在显著差距，这些证据应能考虑到老年人健康表型的实际情况因素，为适用于长寿人群的循证干预措施提供依据，尤其是为术后良好恢复的预测指标提供依据。元研究在老年外科手术中的应用成为解决这一知识差距的重要工具，并揭示了在不久的将来需要解决的机遇和局限性，以便为老年人建立循证外科护理。本手稿的目的是呈现一个与外科护理相关的真实且具有全球相关性的场景，探讨适用于该人群的手术证据的长寿情况、可获得性和质量，并提出在老年外科手术研究和元研究的分析及未来展望中需考虑的变量。
