Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

Watt, Jennifer; Tricco, Andrea C.; Talbot-Hamon, Catherine; Pham, Ba’; Rios, Patricia; Grudniewicz, Agnes; Wong, Camilla L.; Sinclair, Douglas; Straus, Sharon E.

doi:10.1186/s12916-017-0986-2

Cited by 149 publications

(98 citation statements)

References 70 publications

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“…A less clear picture is present when the predictive value of a low psoas mass is compared with the presence of frailty. Different frailty assessments yield different ORs for the prediction of postoperative complications, with ORs ranging 1.80–6.40 . The OR for low psoas mass is in the lower range of this spectrum.…”

Section: Discussionmentioning

confidence: 99%

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Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Weerink

Hoorn

Leeuwen

et al. 2020

J cachexia sarcopenia muscle

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Background Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta‐analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery. Methods PubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta‐analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien‐Dindo grade ≥3, including 30‐day mortality. Heterogeneity was evaluated with I2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date. Results A total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta‐analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30‐day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled: 1.44, 95% CI: 1.24–16.8, P<0.001, I2=55%) and 30‐day mortality (ORpooled: 2.15, 95% CI: 1.46–3.17, P<0.001, I2=14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled: 2.06, 95% CI: 1.37–3.09, ORpooled: 1.32, 95% CI: 1.14–1.53, respectively) and 30‐day mortality [ORpooled: 6.17 (95% CI: 2.71–14.08, ORpooled: 1.80 (95% CI: 1.24–2.62), respectively]. The effect was independent of tumour location and publication date. Conclusions The presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30‐day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

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Section: Discussionmentioning

confidence: 99%

“…Though very effective, surgical treatment may lead to postoperative complications . Especially in frail patients, these complications can lead to permanent functional loss and negatively influence survival and long‐term quality of life . The benefits of surgery should therefore be carefully weighed against these negative sequelae .…”

Section: Introductionmentioning

confidence: 99%

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Weerink

Hoorn

Leeuwen

et al. 2020

J cachexia sarcopenia muscle

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“…Frailty is recognized as one of the strongest preoperative predictors of postoperative complications in one of meta-analysis study recently. 25 Having a clear understanding of postoperative recovery trajectories is essential to help clinicians conduct appropriate discussions about treatment plans with patients and family. 26 The value of Comprehensive Geriatric Assessment (CGA), the current gold standard for frailty assessment among geriatricians, in predicting frailty in colorectal cancer patients was shown by a study conducted by Kristjansson et al, but its applicability in the busy preoperative clinic setting is questionable.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

Hui

et al. 2019

Preprint

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Background Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized frailty assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. Scores ranging from “non-frail” (<=5 points), “vulnerable” (6<=n<=7 points) and “frail” (>=8 points). However, little evaluation of its use has been carried out in the Asians so far. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly Asian patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. Methods This is a prospective observational study done among patients aged 70 years and above attended PAC in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater variability of EFS was also assessed using Bland Altman plot. Results EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement. Conclusion These results show that EFS is able to predict postoperative complications in elderly Asian patients undergoing elective major abdominal surgery. It is also feasible to be incorporated as a standard assessment in the outpatient preoperative clinic setting.

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“…According to a 2017 meta-analysis, sarcopenia and frailty seem to have significant adverse impacts on postoperative outcomes [44]. Another 2018 meta-analysis identified potentially modifiable prognostic factors (i.e., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care [45]. These results lend support to the view that intensive management of preoperative modifiable factors can prevent postoperative complications.…”

Section: Frailtymentioning

confidence: 93%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

Cited by 149 publications

References 70 publications

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

Anesthetic management of geriatric patients

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