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Systematic review and meta‐analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

机译：对脆弱性的系统评价和荟萃分析，作为大腹部手术后发病率和死亡率的预测指标

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Abstract BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long-term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics. MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random-effects meta-analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long-term mortality. The potential effect of the number of domains of the frailty indices was explored through meta-regression at moderator analysis. ResultsA total of 35 studies with 1?153?684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short-term mortality (OR 5·77, 4·41 to 7·55) and long-term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co-morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components. ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.
机译：摘要背景虚弱与预后差有关，但是评估的定义和规模众多，难以评估对结果的影响。这项研究的目的是量化脆弱对大腹部手术后的发病率和死亡率以及长期死亡率的影响，并评估不同脆弱性指标的性能。方法：进行扩展文献检索以检索所有原始文章，以调查脆弱性是否会影响成人人群择期大腹部手术后的结果。考虑了所有可能的脆弱定义。对所有感兴趣的结果进行了随机效应荟萃分析。对于术后发病率和死亡率，总体效果大小以比值比（OR）估算，而危险比（HR）则以长期死亡率计算。在主持人分析中，通过元回归探索了脆弱指数域数的潜在影响。结果总共对35项研究进行了分析，涉及1？153？684位患者。身体虚弱与术后重大疾病风险显着增加（OR 2·56，95％ci 2·08至3·16），短期死亡率（OR 5·77、4·41至7·55）和长期死亡率（HR 2·71、1·63至4·49）。所有域均与术后严重发病率显着相关，OR范围从合并症的1·09（1·00至1·18）到肌肉减少症的2·52（1·32至4·80）。根据脆弱成分的数量，未观察到缓和作用。结论：无论定义域和组合域如何，虚弱与大腹部手术后术后发病和死亡风险增加显着相关。

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