The online version of this article (doi:https://doi.org/10.1186/s12916-017-0986-2) contains supplementary material, which is available to authorized users.
Elective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery.
Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Prospective studies reporting prognostic factors associated with postoperative complications (composite outcome of medical and surgical complications), functional decline, mortality, post-hospitalization discharge destination, and prolonged hospitalization among older adults undergoing elective surgery were included. Study characteristics and prognostic factors associated with the outcomes of interest were extracted independently by two reviewers. Random effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidences of adverse outcomes.
Of the 5692 titles and abstracts that were screened for inclusion, 44 studies (12,281 patients) reported on the following adverse postoperative outcomes: postoperative complications (n =28), postoperative mortality (n = 11), length of hospitalization (n = 21), functional decline (n = 6), and destination at discharge from hospital (n = 13). The pooled incidence of postoperative complications was 25.17% (95% confidence interval (CI) 18.03–33.98%, number needed to follow = 4). The geriatric syndromes of frailty (odds ratio (OR) 2.16, 95% CI 1.29–3.62) and cognitive impairment (OR 2.01, 95% CI 1.44–2.81) were associated with developing postoperative complications; however, there was no association with traditionally assessed prognostic factors such as age (OR 1.07, 95% CI 1.00–1.14) or American Society of Anesthesiologists status (OR 2.62, 95% CI 0.78–8.79). Besides frailty, other potentially modifiable prognostic factors, including depressive symptoms (OR 1.77, 95% CI 1.22–2.56) and smoking (OR 2.43, 95% CI 1.32–4.46), were also associated with developing postoperative complications.
Geriatric syndromes are important prognostic factors for postoperative complications. We identified potentially modifiable prognostic factors (e.g., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care.
Additional file 1: PRISMA Checklist. (DOCX 30 kb)12916_2017_986_MOESM1_ESM.docx
Additional file 2: Appendix 1. MEDLINE search strategy. Appendix 2. Order preference for combining data types in meta-analyses. Appendix 3. Data imputation methods. Appendix 4. Cochrane risk of bias assessment for randomized trials. Appendix 5. Newcastle–Ottawa scale for evaluating the quality of cohort studies. Appendix 6. Table of characteristics of prospective studies reporting prognostic factors associated with postoperative complications among older adults undergoing elective surgery. Appendix 7. Forest plots of study-level and pooled effect estimates for prognostic factors associated with postoperative complications among older adults undergoing elective surgery. Appendix 8. Forest plots of the study-level and pooled effect estimates of the prognostic factors associated with postoperative mortality among older adults undergoing elective surgery. Appendix 9. Forest plot of study-level and pooled effect estimates for prognostic factors associated with prolonged hospitalization among older adults undergoing elective surgery. Appendix 10. Forest plot of study-level and pooled effect estimates for prognostic factors associated with destination at discharge from hospital among older adults undergoing elective surgery (DOCX 550 kb)12916_2017_986_MOESM2_ESM.docx
Kristjansson SR, Jordhøy MS, Nesbakken A, Skovlund E, Bakka A, Johannessen H-O, et al. Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol. 2010;1(2):57–65. CrossRef
World Health Organization. Definition of an Older or Elderly Person. Geneva: WHO; 2010. http://www.who.int/healthinfo/survey/ageingdefnolder/en/index.html. Accessed 21 Dec 2017.
United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2013. ST/ESA/SER.A/348. 2013. http://www.un.org/en/development/desa/population/publications/ageing/WorldPopulationAgeingReport2013.shtml. Accessed 21 Dec 2017.
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Ottawa, Ontario: Ottawa Hospital Research Institute; 2008.
EPOC Risk of Bias Tool. Cochrane Effective Practice and Organization Care Group. 2011. http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/Risk%20of%20Bias%2005-01-2009.doc.
Mayer D. Essential Evidence-Based Medicine. 2nd ed. Cambridge: Cambridge University Press; 2009.
Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.handbook.cochrane.org. Accessed 21 Dec 2017.
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):48. CrossRef
Schwarzer G. meta: An R package for meta-analysis. R News. 2007;7(3):40–5.
Zhang L, Wang C, Sha SY, Kwauk S, Miller AR, Xie MS, et al. Mini-nutrition assessment, malnutrition, and postoperative complications in elderly Chinese patients with lung cancer. J BUON. 2012;17(2):323–6. PubMed
Fried LP, Tange CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56A(3):M146–56. CrossRef
Betomvuko P, Michaux I, Gabriel L, Bihin B, Gourdin M, De Saint Hubert M. Gait speed as predictor of outcomes of elective cardiac surgery in older patients. Eur Geriatric Med. 2015;6(1):S147. CrossRef
Blakoe M, Greve H. Frailty – preoperative assessment and implications for nursing practice following heart surgery. Eur J Cardiovasc Nursing. 2015;14:S44.
Fried LP, Tange CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci. 2001;56A(3):M146–56. CrossRef
Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;3:CD002294.
- Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis
Andrea C. Tricco
Sharon E. Straus
- BioMed Central
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