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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Medicine 1/2018

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

Zeitschrift:
BMC Medicine > Ausgabe 1/2018
Autoren:
Jennifer Watt, Andrea C. Tricco, Catherine Talbot-Hamon, Ba’ Pham, Patricia Rios, Agnes Grudniewicz, Camilla Wong, Douglas Sinclair, Sharon E. Straus
Wichtige Hinweise

Electronic supplementary material

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
Zusatzmaterial
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
Literatur
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