META-ANALYSIS OF CORRELATION BETWEEN PREOPERATIVE ASSESSMENT AND SURGICAL RISK IN FRAIL ELDERLY

Abstract

Objective: This study aimed to investigate whether the relationship between preoperative assessment and surgical risk in older adults is affected by frailty. Methods: PubMed, Embase, Cochrane Library, Web of Science Clinical Trail, CNKI, CBM, Wanfang Database, VIP Database were searched in Chinese and English to collect information on relationship between blood pressure and MACE in different health states of elderly randomized controlled trials or prospective cohort studies. The primary outcome measure was MACE, including all-cause death, cardiovascular death, myocardial infarction, and stroke. Two reviewers independently screened literature, assessed bias, extracted data, and performed Meta-analysis using Stata 14.0 software. Results: A total of 12 prospective cohort studies were included, involving a total of 175,759 elderly people with an average blood pressure of 131-158/68-84, followed up for 4-14 years. The results showed that there was no correlation between hypertension and MACE risk in elderly. Among elderly less than 80 years old, with increase of systolic blood pressure, risk of MACE in non-frail patients increased (HR=1.09, 95%; CI=1.02-1.17); but with every 10 increase in diastolic blood pressure, risk of MACE in frail patients decreased (HR=0.93, 95%; CI=0.88-0.98). Clinical experts use FAME principles to make professional judgments on evidence, formulate review indicators to guide clinical preoperative evaluation and management of geriatric frailty, and recommend clinical preoperative evaluation of elderly surgical patients including frailty, consciousness, activity function and related complications. According to evaluation results, improvement and adjustment of physiological function, disease management, exercise, drug treatment, nutritional status, and mobility are carried out. Conclusion: Hypertension is not associated with risk of MACE in elderly. In non-frail elderly population less than 80 years old, risk of MACE increased with increase of systolic blood pressure, while low diastolic blood pressure was associated with increased risk of MACE in frail. The clinical evidence of preoperative evaluation of frail patients should be updated in a timely manner, and in process of evidence application, clinical situation and existing medical environment, facilitators and obstacles of application of evidence, patient's wishes and preferences and other targeted selection evidence should be evaluated. Evidence-based preoperative assessment of scientific nursing methods can improve preoperative disability status of frail patients, enhance their ability to cope with surgery and related injury stressors, and reduce surgery-related risks.