在上肢骨折后接受手术固定或关节成形术的老年人中，虚弱是否预示着术后并发症和死亡率？系统评价和荟萃分析

摘要(中文译文)

越来越多的人认识到临床衰弱的作用及其对老龄人群健康结局的影响。衰弱可能与骨折后的死亡率和并发症相关；然而，其对上肢结局的影响尚未被量化。本系统综述旨在评估接受上肢骨折手术治疗的成人中，术前衰弱与术后死亡率和并发症之间的关联。次要结局包括再手术、不良出院去向和住院时间。于2025年1月31日检索了MEDLINE、EMBASE和Cochrane CENTRAL数据库，以识别评估成人创伤性上肢骨折后术前患者衰弱与术后结局的研究。提取了30天死亡率、术后并发症、再手术、再入院、不良出院、Clavien-Dindo IV级并发症和住院时间的数据。采用随机效应模型和固定效应模型对数据进行合并以进行荟萃分析。使用推荐分级的评估、制定与评价（GRADE）评估来评价现有证据的质量。在识别的4,013条记录中，9项回顾性队列研究符合纳入条件。衰弱与30天死亡率（比值比[OR] = 3.40，95%置信区间[CI] = 2.90-3.99，< .001）、术后并发症（OR = 2.78，95% CI = 1.99-3.88，< .001）、不良出院（OR = 2.96，95% CI = 1.75-5.02，< .001）和再入院（OR = 3.73，95% CI = 1.86-7.46，< .001）风险增加显著相关。未发现衰弱与再手术之间存在统计学显著关联（OR = 1.61，95% CI = 1.36-1.91，< .001）。推荐分级的评估、制定与评价评估发现，术后并发症和再手术的证据确定性为中等，而30天死亡率、再入院、不良出院、Clavien-Dindo IV级并发症和住院时间的证据确定性为低至极低。术前衰弱与成人上肢骨折手术治疗后早期死亡率增加、术后并发症、不良出院和再入院相关。需要未来的前瞻性研究来标准化衰弱筛查并为上肢骨折的手术决策提供依据。

Abstract

There is growing recognition of the role of clinical frailty and its impact on health outcomes in aging cohorts. Frailty may be associated with mortality and complications following fracture; however, its impact on upper limb outcomes has yet to be quantified. This systematic review aims to evaluate the association between pre-operative frailty and post-operative mortality and complications in adults undergoing surgical treatment for upper limb fractures. Secondary outcomes included reoperation, adverse discharge destination and length of stay. MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched on January 31, 2025, to identify studies that assessed pre-operative patient frailty and post-operative outcomes in adults following traumatic upper limb fractures. Data on 30-day mortality, post-operative complications, reoperation, hospital readmission, adverse discharge, Clavien-Dindo IV complications, and length of stay were extracted. Data were pooled using random-effects and fixed effects models for meta-analyses. Grading of Recommendations Assessment, Development and Evaluation assessment was used to assess the quality of available evidence. Of the 4,013 records identified, 9 retrospective cohort studies were eligible for inclusion. Frailty was significantly associated with increased risk of 30-day mortality (odds ratio [OR] = 3.40, 95% confidence interval [CI] = 2.90-3.99, < .001), post-operative complications (OR = 2.78, 95% CI = 1.99-3.88, < .001), adverse discharge (OR = 2.96, 95% CI = 1.75-5.02, < .001), and hospital readmission (OR = 3.73, 95% CI = 1.86-7.46, < .001). No statistically significant association between frailty and reoperation was found (OR = 1.61, 95% CI = 1.36-1.91, < .001). Grading of Recommendations Assessment, Development and Evaluation assessment found moderate certainty for post-operative complications and reoperation, and low to very low certainty for 30-day mortality, readmission, adverse discharge, Clavien-Dindo IV complications, and length of stay. Pre-operative frailty is associated with increased early mortality, post-operative complications, adverse discharge, and hospital readmission following surgical treatment for upper limb fractures in adults. Future prospective investigations are needed to standardize frailty screening and inform surgical decision-making in upper limb fractures.

如何引用

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