A Systematic Review and Meta-Analysis of Preoperative Frailty Instruments Derived From Electronic Health Data.

Autor:	Alkadri J; From the Department of Anesthesiology & Pain Medicine., Hage D; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Nickerson LH; From the Department of Anesthesiology & Pain Medicine., Scott LR; Department of General Surgery, Queen's University, Ottawa, Ontario, Canada., Shaw JF; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada., Aucoin SD; From the Department of Anesthesiology & Pain Medicine., McIsaac DI; From the Department of Anesthesiology & Pain Medicine.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2021 Nov 01; Vol. 133 (5), pp. 1094-1106.
DOI:	10.1213/ANE.0000000000005595
Abstrakt:	Background: Frailty is a strong predictor of adverse outcomes in the perioperative period. Given the increasing availability of electronic medical data, we performed a systematic review and meta-analysis with primary objectives of describing available frailty instruments applied to electronic data and synthesizing their prognostic value. Our secondary objectives were to assess the construct validity of frailty instruments that have been applied to perioperative electronic data and the feasibility of electronic frailty assessment. Methods: Following protocol registration, a peer-reviewed search strategy was applied to Medline, Excerpta Medica dataBASE (EMBASE), Cochrane databases, and the Comprehensive Index to Nursing and Allied Health literature from inception to December 31, 2019. All stages of the review were completed in duplicate. The primary outcome was mortality; secondary outcomes included nonhome discharge, health care costs, and length of stay. Effect estimates adjusted for baseline illness, sex, age, procedure, and urgency were of primary interest; unadjusted and adjusted estimates were pooled using random-effects models where appropriate or narratively synthesized. Risk of bias was assessed. Results: Ninety studies were included; 83 contributed to the meta-analysis. Frailty was defined using 22 different instruments. In adjusted data, frailty identified from electronic data using any instrument was associated with a 3.57-fold increase in the odds of mortality (95% confidence interval [CI], 2.68-4.75), increased odds of institutional discharge (odds ratio [OR], 2.40; 95% CI, 1.99-2.89), and increased costs (ratio of means, 1.54; 95% CI, 1.46-1.63). Most instruments were not multidimensional, head-to-head comparisons were lacking, and no feasibility data were reported. Conclusions: Frailty status derived from electronic data provides prognostic value as it is associated with adverse outcomes, even after adjustment for typical risk factors. However, future research is required to evaluate multidimensional instruments and their head-to-head performance and to assess their feasibility and clinical impact. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2021 International Anesthesia Research Society.)
Databáze:	MEDLINE
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