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Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.

ABSTRACT: IMPORTANCE:Age has historically been used to predict negative post-surgical outcomes. The concept of frailty was introduced to explain the discrepancies that exist between patients' chronological and physiological age. The efficacy of the modified frailty index (mFI) to predict surgical risk is not clear. OBJECTIVE:We sought to synthesize the current literature to quantify the impact of frailty as a prognostic indicator across all surgical specialties. DATA SOURCES:Pubmed and Cochrane databases were screened from inception to 1 January 2018. STUDY SELECTION:Studies utilizing the modified Frailty Index (mFI) as a post-operative indicator of any type of surgery. The mFI was selected based on a preliminary search showing it to be the most commonly applied index in surgical cohorts. DATA EXTRACTION AND SYNTHESIS:Articles were selected via a two-stage process undertaken by two reviewers (AP and DS). Statistical analysis was performed in Revman (Review manager V5.3). The random-effects model was used to calculate the Risk Ratios (RR). MAIN OUTCOME(S) AND MEASURE(S):The primary outcomes: post-operative complications, re-admission, re-operation, discharge to a skilled care facility, and mortality. RESULTS:This meta-analysis of 16 studies randomizes 683,487 patients, 444,885 frail, from gastrointestinal, vascular, orthopedic, urogenital, head and neck, emergency, neurological, oncological, cardiothoracic, as well as general surgery cohorts. Frail patients were more likely to experience complications (RR 1.48, 95%CI 1.35-1.61; p?

SUBMITTER: Panayi AC

PROVIDER: S-EPMC6536365 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.

Panayi A C AC Orkaby A R AR Sakthivel D D Endo Y Y Varon D D Roh D D Orgill D P DP Neppl R L RL Javedan H H Bhasin S S Sinha I I

American journal of surgery 20181127 2

<h4>Importance</h4>Age has historically been used to predict negative post-surgical outcomes. The concept of frailty was introduced to explain the discrepancies that exist between patients' chronological and physiological age. The efficacy of the modified frailty index (mFI) to predict surgical risk is not clear.<h4>Objective</h4>We sought to synthesize the current literature to quantify the impact of frailty as a prognostic indicator across all surgical specialties.<h4>Data sources</h4>Pubmed a ...[more]

PMID: 30509455

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Project description:BackgroundDegenerative spinal diseases are common in older adults with concurrent frailty. Preoperative frailty is a strong predictor of adverse clinical outcomes after surgery. This study aimed to investigate the association between health-related outcomes and frailty in patients undergoing spine surgery for degenerative spine diseases.MethodsA systematic review and meta-analysis were performed by electronically searching Ovid-MEDLINE, Ovid-Embase, Cochrane Library, and CINAHL for eligible studies until July 16, 2022. We reviewed all studies, excluding spinal tumours, non-surgical procedures, and experimental studies that examined the association between preoperative frailty and related outcomes after spine surgery. A total of 1,075 articles were identified in the initial search and were reviewed by two reviewers, independently. Data were subjected to qualitative and quantitative syntheses by meta-analytic methods.ResultsThirty-eight articles on 474,651 patients who underwent degenerative spine surgeries were included and 17 papers were quantitatively synthesized. The health-related outcomes were divided into clinical outcomes and patient-reported outcomes; clinical outcomes were further divided into postoperative complications and supportive management procedures. Compared to the non-frail group, the frail group was significantly associated with a greater risk of high mortality, major complications, acute renal failure, myocardial infarction, non-home discharge, reintubation, and longer length of hospital stay. Regarding patient-reported outcomes, changes in scores between the preoperative and postoperative Oswestry Disability Index scores were not associated with preoperative frailty.ConclusionsIn degenerative spinal diseases, frailty is a strong predictor of adverse clinical outcomes after spine surgery. The relationship between preoperative frailty and patient-reported outcomes is still inconclusive. Further research is needed to consolidate the evidence from patient-reported outcomes.

Project description:PURPOSE:Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. METHODS:We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials.gov. All study designs with the exception of narrative reviews, case reports, and editorials were included. Included studies assessed frailty in patients greater than 18 years of age admitted to an ICU and compared outcomes between fit and frail patients. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were hospital and long-term mortality. We also determined the prevalence of frailty, the impact on other patient-centered outcomes such as discharge disposition, and health service utilization such as length of stay. RESULTS:Ten observational studies enrolling a total of 3030 patients (927 frail and 2103 fit patients) were included. The overall quality of studies was moderate. Frailty was associated with higher hospital mortality [relative risk (RR) 1.71; 95% CI 1.43, 2.05; p < 0.00001; I 2 = 32%] and long-term mortality (RR 1.53; 95% CI 1.40, 1.68; p < 0.00001; I 2 = 0%). The pooled prevalence of frailty was 30% (95% CI 29-32%). Frail patients were less likely to be discharged home than fit patients (RR 0.59; 95% CI 0.49, 0.71; p < 0.00001; I 2 = 12%). CONCLUSIONS:Frailty is common in patients admitted to ICU and is associated with worsened outcomes. Identification of this previously unrecognized and vulnerable ICU population should act as the impetus for investigating and implementing appropriate care plans for critically ill frail patients. Registration: PROSPERO (ID: CRD42016053910).

Project description:BackgroundFrail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice.ObjectiveWe aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice.DesignA systematic review and Meta-analysis of 16 cohort studies.ParticipantsPatients with COVID-19.MethodsA systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects.ResultsAccording to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay.ConclusionsIn this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.

Project description:To investigate whether high body mass index (BMI) had adverse effects on the postoperative outcomes for patients who underwent anterior or posterior cervical fusion procedures. A literature search were conducted in PubMed, Embase, and Web of Science. Comparative or controlled studies that examined the influences of high BMI on postoperative outcomes after cervical fusion procedures were included. Using a fixed-effect model or random-effect model, the effects of high BMI were determined by weight mean difference (WMD) with 95% confidence interval (95% CI) or risk ratio (RR) with 95% CI. A total of seven studies were included in this meta-analysis. The pooled estimate showed that high BMI was associated with longer hospital stay (WMD?=?1.61 days, 95% CI: 0.51, 2.71; P?=?0.004), longer surgical time (WMD?=?4.55, 95% CI: 1.04, 8.07; P?=?0.011), higher mortality rate (RR?=?3.01, 95% CI: 2.75, 3.29; P?<?0.001), and higher postoperative rates of cardiac complication (RR?=?1.30, 95% CI: 1.11, 1.52; P?=?0.001), deep venous thromboembolism (RR?=?2.29, 95% CI: 1.36, 3.86; P?=?0.002), and wound complication (RR?=?1.69, 95% CI: 1.26, 2.28; P?<?0.001). However, there was no significant differences between high and normal BMI groups in terms of Neck Disability Index (WMD?=?1.49, 95% CI: -2.34, 5.32; P?=?0.447), SF-36 Mental Component Score (MCS) (WMD?=?-0.87, 95% CI: -2.09, 0.35; P?=?0.164), overall complications (RR?=?1.18, 95% CI: 0.80, 1.76; P?=?0.399), central nervous system (CNS) complications (RR?=?0.68, 95% CI: 0.17, 2.76; P?=?0.586), pulmonary complications (RR?=?1.46, 95% CI: 0.87, 2.46; P?=?0.150), and septic complications (RR?=?0.87, 95% CI: 0.32, 2.38; P?=?0.785).High BMI seemed to be associated with longer hospital stay, surgical time, and higher postoperative complication rates compared to normal BMI. Therefore, high BMI patients should be counseled carefully regarding the risk of postoperative complications and surgical outcomes after cervical fusion procedures.

Dataset Information

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.

Publications

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.

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