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中华损伤与修复杂志(电子版) ›› 2025, Vol. 20 ›› Issue (03) : 233 -240. doi: 10.3877/cma.j.issn.1673-9450.2025.03.008

论著

衰弱指数与腰椎术后并发症关系的荟萃分析
韩冰1, 毕宇彤2, 何达3,()   
  1. 1. 100035 首都医科大学附属北京积水潭医院护理部
    2. 100069 首都医科大学护理学院
    3. 100035 首都医科大学附属北京积水潭医院脊柱外科
  • 收稿日期:2025-02-20 出版日期:2025-06-01
  • 通信作者: 何达
  • 基金资助:
    北京市属医院科研培育项目(PX2022017)

Meta-analysis of relationship between frailty index and postoperative complications after lumbar spinal surgery

Bing Han1, Yutong Bi2, Da He3,()   

  1. 1. Department of Nursing,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China
    2. School of Nursing,Capital Medical University,Beijing 100069,China
    3. Department of Spinal Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China
  • Received:2025-02-20 Published:2025-06-01
  • Corresponding author: Da He
引用本文:

韩冰, 毕宇彤, 何达. 衰弱指数与腰椎术后并发症关系的荟萃分析[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(03): 233-240.

Bing Han, Yutong Bi, Da He. Meta-analysis of relationship between frailty index and postoperative complications after lumbar spinal surgery[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2025, 20(03): 233-240.

目的

探讨衰弱指数(FI)与腰椎术后并发症的关系。

方法

检索PubMed、Cochrane Library、Web of Science、EMbase、CINAHL、中国知网、维普数据库、万方医学数据库、中国生物医学文献数据库中关于FI与腰椎术后并发症相关的文献,检索时限为建库至2025年1月1日。由两名研究人员独立进行文献筛选、质量评价以及数据提取,采用Stata 18.0软件进行荟萃分析。

结果

本文共纳入14 项研究。荟萃分析结果显示,衰弱患者腰椎术后有较高风险发生任意并发症(OR=1.67,95% CI:1.38~2.01,P<0.001)、死亡(OR=9.33,95%CI:1.41~61.71,P<0.001)、肺部并发症(OR=3.09,95%CI:2.36~4.05,P=0.341)、泌尿系统并发症(OR=1.74,95%CI:1.08~2.83,P=0.044)、心脏并发症(OR=2.99,95%CI:2.36~3.80,P=0.941)、脑血管疾病(OR=2.94,95%CI:2.12~4.07,P=0.983)、败血症(OR=1.92,95%CI:1.61~2.29,P=0.473)、手术部位感染(OR=1.51,95%CI:1.29~1.76,P=0.741)、术后输血(OR=1.36,95%CI:1.17~1.59,P=0.289)、再次入院(OR=1.59,95%CI:1.23~2.06,P=0.284)以及再次手术(OR=1.36,95%CI:1.07~1.73,P=0.294),但术前衰弱与术后胃肠道并发症(OR=0.86,95%CI:0.55~1.37,P=0.396)、谵妄(OR=1.33,95%CI:0.93~1.91,P=0.480)、深静脉血栓(OR=1.10,95%CI:0.89~1.36,P=0.915)的发生统计学上无显著关联。

结论

衰弱患者腰椎术后发生并发症的风险明显高于非衰弱患者,医护人员应重视对接受腰椎手术的患者进行衰弱筛查并尽早干预,以改善患者的预后。

Objective

To systematically evaluate the relationship between frailty index (FI) and postoperative complications after lumbar spinal surgery.

Methods

This article retrieved relevant studies about the relationship between FI and postoperative complications after lumbar spinal surgery from PubMed,Cochrane Library, Web of Science, EMbase, CINAHL, CNKI, VIP database, Wanfang Medical Database and China Biomedical Literature Database.The retrieval time limit was from the establishment of the database to January 1, 2025.Two researchers independently conducted literature screening, quality evaluation, and data extraction.Stata 18.0 software was used for meta-analysis.

Results

A total of 14 articles were included.Meta-analysis results showed that frail patients had a higher risk of any postoperative complications after lumbar spinal surgery (OR=1.67,95% CI:1.38~2.01,P<0.001), death (OR=9.33,95%CI:1.41~61.71,P<0.001), pulmonary complications (OR=3.09,95%CI:2.36~4.05,P=0.341), urinary complications (OR=1.74,95%CI:1.08~2.83,P=0.044),cardiac complications (OR=2.99,95%CI:2.36~3.80,P=0.941), cardiovascular disease (OR=2.94,95%CI:2.12~4.07,P=0.983),sepsis (OR=1.92,95%CI:1.61~2.29,P=0.473),surgical site infections (OR=1.51,95%CI:1.29~1.76,P=0.741),postoperative transfusion (OR=1.36,95%CI:1.17~1.59,P=0.289), readmission (OR=1.59,95%CI:1.23~2.06,P=0.284) and reoperation (OR=1.36,95%CI:1.07~1.73,P=0.294), but there was no statistically significant association between preoperative frailty and postoperative gastrointestinal complications (OR=0.86,95%CI:0.55~1.37,P=0.396), delirium (OR=1.33,95%CI:0.93~1.91,P=0.480) and deep vein thrombosis (OR=1.10,95%CI:0.89~1.36,P=0.915).

Conclusion

Frail patients have a significantly higher risk of postoperative complications after lumbar surgery compared to non-frail patients.Medical and nursing staff should pay attention to the screening of patients' frailty and intervene as soon as possible to improve the prognosis of patients.

表1 纳入文献的基本特征(n=14)
第一作者 发表年份 文献性质 研究对象 年龄(岁) 病例数(例) 衰弱量表 随访时间(月) 报道的结局指标 NOS评分
Sun等[3] 2020 回顾性 非ASD >65 426 mFI-11 12 (1) 9
Weu等[9] 2023 回顾性 非ASD >65 202 mFI-11 1 (1)(3)(4)(9)(11)(13)(14) 7
Phan等[10] 2017 回顾性 非ASD ≥18 3 920 mFI-11 1 (1)(2)(3)(4)(5)(9)(11)(12)(14) 6
Li等[11] 2021 回顾性 ASD ≥50 161 mFI-11 24 (1)(3)(4)(5)(6)(7)(8)(9)(11) 7
Leven等[12] 2016 回顾性 ASD ≥18 1 001 mFI-11 1 (1)(2)(3)(4)(5)(9)(10)(11)(12)(14) 8
Patel等[13] 2022 回顾性 非ASD >50 11 711 mFI-5 1 (1)(2)(3)(4)(5)(8)(9)(10)(11)(12)(13)(14) 7
Madelar等[14] 2024 回顾性 ASD >40 208 mFI-5 60 (1)(2)(3)(4)(5)(6)(7)(9)(14) 6
Luu等[15] 2024 回顾性 ASD ≥18 340 mFI-5 1 (1)(3)(4)(5)(6)(10)(11)(12)(13)(14) 7
Camino等[16] 2022 回顾性 非ASD ≥18 53 252 mFI-5 1 (1)(3)(4)(5)(8)(9)(10)(11)(12)(14) 6
Owodunni等[17] 2023 回顾性 非ASD >65 49 754 mFI-5 1 (1)(2)(13) 9
Gu等[18] 2023 回顾性 ASD ≥18 212 ASD-FI 12 (1)(7)(11)(14) 7
Pierce等[19] 2020 回顾性 ASD ≥18 191 ASD-FI 12 (1)(6)(7) 9
Miller等[20] 2018 回顾性 ASD ≥18 266 ASD-FI 24 (1)(11)(14) 9
Flexman等[21] 2016 回顾性 非ASD ≥18 52 671 mFI-11 1 (1) 6
图1 文献筛选流程及结果
表2 衰弱与腰椎术后患者发生任意并发症的亚组分析结果
图2 衰弱与腰椎术后患者发生任意并发症间关系的森林图
图3 衰弱与腰椎术后患者发生任意并发症的敏感性分析
图4 衰弱与腰椎术后患者死亡间关系的森林图
图5 衰弱与腰椎术后患者死亡的敏感性分析
表3 衰弱与腰椎术后并发症关系的荟萃分析结果
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