Department of General Surgery, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Langenbecks Arch Surg. 2024 Nov 18;409(1):352. doi: 10.1007/s00423-024-03537-z.
Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy.
In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model.
Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65-18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51-4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52-8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08-13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91-4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates.
This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.
尽管胆囊切除术是一种常见的手术，但老年人术后并发症和死亡率的风险更高。年龄本身并不是术后结果的可靠预测指标，而虚弱可能更准确地评估患者的健康和功能状态。虚弱表现为身体恶化和恢复能力下降，已被证明可预测包括胆囊切除术在内的各种手术后的死亡率、恢复时间延长和发病率。因此，将虚弱评估纳入术前评估可以通过个性化治疗策略来改善患者的预后。本系统评价和荟萃分析旨在评估虚弱状况对胆囊切除术后术后结果的预测程度。
根据 PRISMA 指南，我们于 2024 年 8 月 14 日在 PubMed、Embase 和 Web of Science 上进行了无出版年限或语言限制的搜索。使用纽卡斯尔-渥太华量表评估研究质量，并使用优势比（OR）及其 95%置信区间（CI）作为效应量进行荟萃分析，采用随机效应模型。
共纳入 9 项队列研究，总计 128421 名参与者。汇总结果显示，虚弱患者短期死亡率（OR：5.54，95%CI：1.65-18.60，p=0.006）、术后发病率（OR：2.65，95%CI：1.51-4.64，p=0.001）、主要发病率（OR：3.61，95%CI：1.52-8.59）和呼吸衰竭（OR：3.85，95%CI：1.08-13.79）的几率显著更高。此外，虚弱患者的住院时间更长（平均差异：2.98 天，95%CI：1.91-4.04），且术后感染和败血症的几率显著更高。然而，与再次手术率无关。
本研究强调了在术前使用虚弱评估工具预测胆囊切除术后结果的价值。这些工具可以改善急诊和择期情况下的决策制定，有助于在手术和药物治疗之间、开放手术和腹腔镜手术之间进行选择，以适应每位患者的情况。
