Zhao Shan, Wang Bei, Liu Meinv, Yu Dongdong, Li Jianli
Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China.
Graduate Faculty, North China University of Science and Technology, Tangshan, Hebei, China.
J Res Med Sci. 2024 Jul 30;29:47. doi: 10.4103/jrms.jrms_694_23. eCollection 2024.
Perioperative neurocognitive disorders (PNDs) were the most common complication in elderly patients undergoing surgery. Early identification of risk factors for PNDs and implementation of preventive measures were critical to improve prognosis. We performed this systematic review and meta-analysis to explore the impact of preoperative frailty on PNDs in elderly surgical patients.
Systematic searches were performed in PubMed, Embase, and Web of Science. A fixed-effect model in RevMan5.3 software was conducted due to the low heterogeneity. The potential risk bias was assessed through Funnel plot and Egger's test. Sensitivity analysis was used to examine the robustness of the outcomes.
Sixteen cohort studies enrolling 4805 elderly patients were qualified for meta-analysis. Pooled results showed that preoperative frailty was linked to the development of PNDs (pooled odds ratio [OR]: 2.40, 95% confidence interval [CI]: 2.05-2.80, < 0.001) without obvious heterogeneity ( = 0.19, = 22%). Subgroup analyses revealed that the correlation between preoperative frailty and PNDs was more remarkable in prospective cohort studies (OR: 3.11, 95% CI: 2.47-3.91, < 0.001) compared to retrospective cohort studies (OR: 1.94, 95% CI: 1.57-2.39, < 0.001; test for subgroup difference, = 0.003). In addition, the correlation in patients with cardiac surgery (OR: 3.38, 95% CI: 2.44-4.68, < 0.001) was more noticeable than noncardiac surgery (OR: 2.17, 95% CI: 1.82-2.59, < 0.001; test for subgroup difference = 0.02).
Our results demonstrated that preoperative frailty was independently associated with PNDs in geriatric patients undergoing elective surgery.
围手术期神经认知障碍（PNDs）是老年手术患者中最常见的并发症。早期识别PNDs的危险因素并采取预防措施对改善预后至关重要。我们进行了这项系统评价和荟萃分析，以探讨术前衰弱对老年手术患者PNDs的影响。
在PubMed、Embase和Web of Science中进行系统检索。由于异质性较低，在RevMan5.3软件中采用固定效应模型。通过漏斗图和Egger检验评估潜在的风险偏倚。采用敏感性分析来检验结果的稳健性。
16项纳入4805例老年患者的队列研究符合荟萃分析的条件。汇总结果显示，术前衰弱与PNDs的发生相关（汇总比值比[OR]：2.40，95%置信区间[CI]：2.05 - 2.80，P < 0.001），且无明显异质性（I² = 0.19，P = 22%）。亚组分析显示，与回顾性队列研究（OR：1.94，95% CI：1.57 - 2.39，P < 0.001；亚组差异检验，P = 0.003）相比，术前衰弱与PNDs之间的相关性在前瞻性队列研究中更为显著（OR：3.11，95% CI：2.47 - 3.91，P < 0.001）。此外，心脏手术患者中的相关性（OR：3.38，95% CI：2.44 - 4.68，P < 0.001）比非心脏手术患者更明显（OR：2.17，95% CI：1.82 - 2.59，P < 0.001；亚组差异检验P = 0.02）。
我们的结果表明，术前衰弱与接受择期手术的老年患者的PNDs独立相关。
