利用临床虚弱量表预测急诊开腹手术后短期和长期不良后果:荟萃分析。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae078
Brittany Park, Zena Alani, Edrick Sulistio, Ahmed W H Barazanchi, Jonathan Koea, Alain Vandal, Andrew G Hill, Andrew D MacCormick
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引用次数: 0

摘要

背景:急诊开腹手术的发病率和死亡率都很高。在这种情况下,虚弱程度评估仍未得到充分利用,部分原因在于时间限制和可行性。临床虚弱量表已被确定为对急诊开腹手术患者进行虚弱评估的最合适工具,并被推荐用于所有接受急诊开腹手术的老年患者。使用临床虚弱量表测量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:通过系统检索 Medline、Embase、Scopus 和 CENTRAL 数据库(截至 2024 年 2 月),发现了观察性队列研究,这些研究比较了根据临床虚弱量表定义的虚弱和非虚弱参与者进行急诊开腹手术后的结果。主要结果是短期和长期死亡率。建立了一个随机效应模型,对效应估计值进行了汇总,并编写了一份单独的叙述性综述。对偏倚风险进行了评估:共纳入了 12 篇文章,涉及 5704 名患者。所有患者中虚弱发生率为 25%,老年人(年龄≥55 岁)中虚弱发生率为 32%。老年虚弱患者的术后死亡风险明显更高(30 天死亡率 OR 3.84,95% c.i. 2.90 至 5.09;1 年死亡率 OR 3.03,95% c.i. 2.17 至 4.23)。元回归显示,定义虚弱的临界值的不同并不会显著影响虚弱与 30 天死亡率的关系。体弱与较高的主要并发症发生率(OR 1.93,95% c.i.1.27-2.93)和出院后接受更高级别的护理有关:结论:体弱与急诊开腹手术后的短期和长期死亡率以及不良发病率和功能性结果密切相关。使用临床虚弱量表识别虚弱程度有助于以患者为中心做出决策,并为这些 "高危 "患者实施量身定制的护理策略,从而减少急诊开腹手术后的不良后果。
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Frailty using the Clinical Frailty Scale to predict short- and long-term adverse outcomes following emergency laparotomy: meta-analysis.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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