Background

Preoperative frailty may be a strong predictor of adverse postoperative outcomes. We investigated the association between frailty and clinical outcomes in surgical patients admitted to the ICU.

Methods

PubMed, Embase, and Ovid MEDLINE were searched for relevant articles. We included full-text original English articles that used any frailty measure, reporting results of surgical adult patients (≥18 yr old) admitted to ICUs with mortality as the main outcome. Data on mortality, duration of mechanical ventilation, ICU and hospital length of stay, and discharge destination were extracted. The quality of included studies and risk of bias were assessed using the Newcastle Ottawa Scale. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results

Thirteen observational studies met inclusion criteria. In total, 58 757 patients were included; 22 793 (39.4%) were frail. Frailty was associated with an increased risk of short-term (risk ratio [RR]=2.66; 95% confidence interval [CI]: 1.99–3.56) and long-term mortality (RR=2.66; 95% CI: 1.32–5.37). Frail patients had longer ICU length of stay (mean difference [MD]=1.5 days; 95% CI: 0.8–2.2) and hospital length of stay (MD=3.9 days; 95% CI: 1.4–6.5). Duration of mechanical ventilation was longer in frail patients (MD=22 h; 95% CI: 1.7–42.3) and they were more likely to be discharged to a healthcare facility (RR=2.34; 95% CI: 1.36–4.01).

Conclusion

Patients with frailty requiring postoperative ICU admission for elective and non-elective surgeries had increased risk of mortality, lengthier admissions, and increased likelihood of non-home discharge. Preoperative frailty assessments and risk stratification are essential in patient and clinician planning, and critical care resource utilisation.

Clinical trial registration

PROSPERO CRD42020210121.

中文翻译：

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重症监护室手术患者虚弱与临床结果之间的关联：系统评价和荟萃分析

背景

术前虚弱可能是术后不良结局的强有力预测因素。我们调查了入住 ICU 的手术患者的虚弱与临床结果之间的关联。

方法

搜索了 PubMed、Embase 和 Ovid MEDLINE 的相关文章。我们纳入了使用任何脆弱措施的全文原始英文文章，报告了以死亡率为主要结果的入住 ICU 的手术成人患者（≥18 岁）的结果。提取死亡率、机械通气时间、ICU和住院时间以及出院目的地的数据。使用纽卡斯尔渥太华量表评估纳入研究的质量和偏倚风险。数据是根据系统评价和荟萃分析指南的首选报告项目合成的。

结果

十三项观察性研究符合纳入标准。共纳入 58 757 名患者；22 793 (39.4%) 人身体虚弱。虚弱与短期（风险比 [RR]=2.66；95% 置信区间 [CI]：1.99-3.56）和长期死亡率（RR=2.66；95% CI：1.32-5.37）风险增加相关. 体弱患者的 ICU 住院时间更长（平均差 [MD]=1.5 天；95% CI：0.8-2.2）和住院时间（MD=3.9 天；95% CI：1.4-6.5）。体弱患者的机械通气时间较长（MD=22 小时；95% CI：1.7-42.3），他们更有可能出院到医疗机构（RR=2.34；95% CI：1.36-4.01）。

结论

因选择性和非选择性手术而需要术后入住 ICU 的虚弱患者死亡率增加、住院时间延长和非居家出院的可能性增加。术前虚弱评估和风险分层对于患者和临床医生的计划以及重症监护资源的利用至关重要。

临床试验注册

PROSPERO CRD42020210121。