Background There are various frailty assessment tools in the world,and the application choice of frailty assessment tools for the geriatric perioperative population varies.It remains unclear which frailty assessment tool is more suitable for the perioperative population in China.Objective To compare the application effects of FRAIL scale,Clinical Frailty Scale(CFS),perioperative frailty index and 5-item modified frailty index(mFI-5)in preoperative frailty assessment in elderly surgical patients,in order to provide a reference for healthcare professionals to choose appropriate frailty assessment tools.Methods By convenient sampling method,a total of 329 hospitalized elderly patients admitted to Guangdong Hospital of Traditional Chinese Medicine for elective surgery from February to May 2023 were selected.The mFI-11,FRAIL scale,CFS,mFI-5 and perioperative frailty index were used for frailty assessment.The Kappa test was used to evaluate the consistency between the five frailty assessment tools.Using the mFI-11 evaluation results as a reference,the diagnostic value of the other four tools on the incidence of preoperative frailty in elderly patients was analyzed by decision curve analysis(DCA)and receiver operating characteristic(ROC)curve,and the area under ROC curve(AUC)was calculated.The optimal cut-off values of the four frailty assessment tools were determined according to the Yoden index.The performance indicators of the four frailty assessment tools at the original and optimal cut-off values were calculated.Results CFS and perioperative frailty index showed the highest consistency in the assessment of preoperative frailty in the elderly(Kappa=0.655,P<0.001),FRAIL had the lowest consistency with mFI-5 and mFI-11 in the evaluation of preoperative frailty in the elderly(Kappa=0.182,0.262).ROC results showed that the AUC of mFI-5,perioperative frailty index,CFS and FRAIL for preoperative frailty screening in the elderly were 0.920,0.888,0.823 and 0.799,respectively.The AUC of mFI-5 in screening preoperative frailty in the elderly was greater than that of FRAIL scale and CFS(Z=3.188,3.215;P=0.001).The AUC of perioperative frailty index was greater than that of FRAIL scale(Z=2.561,P=0.001).The sensitivity(91.18%)and specificity(84.41%)of mFI-5,the sensitivity(94.12%)and specificity(71.86%)of perioperative frailty index were higher in the optimal cut-off value.The DCA results showed that the net benefit of mFI-5 was the highest,followed by perioperative frailty index within the relevant risk thresholds.Conclusion The screening accuracy of mFI-5 is the highest,with high sensitivity and specificity at the optimal critical value.The perioperative frailty index has the second highest screening accuracy but relatively good overall predictive performance.Both of them are suitable for early frailty risk screening in elderly surgical patients.

There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11). A prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty. 335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0

Background Cognitive frailty is defined as the coexistence of physical frailty and mild cognitive impairment, which is associated with adverse outcomes. Due to various factors such as age-related changes in the brain and the presence of comorbidities, the elderly are more susceptible to cognitive frailty. Objective To investigate the effect of preoperative cognitive frailty on postoperative complications in elderly patients. Methods This prospective observational study was conducted among 253 patients aged 60–85 years, who underwent elective orthopedic and abdominal surgery (postoperative hospital stay ≥ 3 days ) in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May 2023 to November 2023. Cognitive frailty was assessed using the MoCA for the cognitive status and the Fried criteria for five frailty scales. The participants were split into the following groups: group A, neither frail nor cognitive impairment; group B, only frailty ; group C, only cognitive impairment; group D, cognitive frailty. Primary outcome was the impact on postoperative complications. Secondary outcomes included mobility disability, prolonged hospital stay, re-operation and 90-day readmission. Results The median age ( interquartile range ) of participants was 69 (65–73) years, of which 40.3% were male. The prevalence of cognitive frailty was 17.8%. The incidence of postoperative complications was 18.2% in group A, 50.0% in group B, 37.4% in group C, and 75.6% in group D. The difference was significant ( P < 0.001). In the multivariate analysis, cognitive frailty [odds ratio (OR), 16.84; 95% confidence interval (CI), 4.54–62.37], only frailty (OR, 7.86; 95%CI, 2.12-29. 12), only cognitive impairment (OR, 4.22; 95%CI, 1.62–11.02). Conclusions Cognitive frailty was associated with higher risks of postoperative complications in elderly patients undergoing general anesthesia. It indicates that clinicians should pay much attention to these elderly with cognitive frailty.

Surgical Site Infection (SSI) is one of the common postoperative complications after gastric cancer surgery. Previous studies have explored the risk factors (such as age, diabetes, anaemia and ASA score) for SSI in patients with gastric cancer. However, there are large differences in the research results, and the correlation coefficients of different research results are quite different. We aim to investigate the risk factors of surgical site infection in patients with gastric cancer. We queried four English databases (PubMed, Embase, Web of Science and the Cochrane Library) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biological Medicine Database, Wanfang Database and Chinese Scientific Journal Database (VIP Database)) to identify published literature related to risk factors for surgical site infection in patients with gastric cancer. Rev Man 5.4 and Stata 15.0 were used in this meta-analysis. A total of 15 articles (n = 6206) were included in this analysis. The following risk factors were found to be significantly associated with surgical site infection in gastric cancer: male (OR = 1.28, 95% CI [1.06, 1.55]), age >60 (OR = 2.75, 95% CI [1.65, 4.57]), smoking (OR = 1.99, 95% CI [1.46, 2.73]), diabetes (OR = 2.03, 95% CI [1.59, 2.61]), anaemia (OR = 4.72, 95% CI [1.66, 13.40]), preoperative obstruction (OR = 3.07, 95% CI [1.80, 5.23]), TNM ≥ III (OR = 2.05, 95% CI [1.56, 2.70]), hypoproteinemia (OR = 3.05, 95% CI [2.08, 4.49]), operation time ≥3 h (OR = 8.33, 95% CI [3.81, 18.20]), laparotomy (OR = 2.18, 95% CI [1.61, 2.94]) and blood transfusion (OR = 1.44, 95% CI [1.01, 2.06]). This meta-analysis showed that male, age >60, smoking, diabetes, anaemia, preoperative obstruction, TNM ≥ III, hypoproteinemia, operation time ≥3 h, open surgery and blood transfusion were the risk factors for SSI in patients with gastric cancer.

目的 系统评价胃癌患者术后肺部感染的危险因素.方法 计算机检索PubMed、The Cochrane Library、Embase、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库关于胃癌患者术后肺部感染危险因素的文献,检索时间设定为从建库至2021年8月31日,运用RevMan5.4软件和Stata15.0软件进行Meta分析.结果 最终纳入19篇文献,共13764例患者.Mete分析结果表明,年龄(WMD=4.53,95％CI:2.87～6.18,P<0.00001)、年龄≥60岁(OR=1.88,95％CI:1.22～2.90,P=0.004)、性别(OR=1.49,95％CI:1.28～1.73,P<0.00001)、吸烟(OR=2.07,95％CI:1.52～2.83,P<0.00001)、低蛋白血症(OR=2.85,95％CI:1.15～7.04,P=0.02)、COPD(OR=3.32,95％CI:1.83～6.00,P<0.0001)、肺部疾病(OR=2.39,95％CI:1.60～3.57,P<0.0001)、高血压(OR=1.52,95％CI:1.18～1.95,P=0.001)、糖尿病(OR=1.90,95％CI:1.50～2.41,P<0.00001)、开腹手术(OR=1.40,95％CI:1.15～1.70,P=0.0007)、手术时间(WMD=23.38,95％CI:3.10～43.65,P=0.02)、手术时间≥4h(OR=2.13,95％CI:1.40～3.24,P=0.0004)、围手术期输血(OR=3.56,95％CI:2.56～4.96,P<0.00001)、留置胃管时间≥5d(OR=3.25,95％CI:1.71～6.16,P=0.0003)、伤口疼痛(OR=4.26,95％CI:2.43～7.47,P<0.00001)是胃癌患者术后肺部感染的危险因素,差异有统计学意义(P<0.05).而BMI、心脏疾病、术中出血量与胃癌患者术后肺部感染的相关性差异无统计学意义(P>0.05).结论 胃癌患者术后肺部感染的危险因素多样,应及时识别高危人群,并采取针对性措施,降低术后发生肺部感染风险.

背景 急性肾损伤是重症急性胰腺炎常见并发症之一，是重症急性胰腺炎患者预后不良的重要危险因素。防治重症急性胰腺炎患者并发急性肾损伤形势严峻，早期评估、干预相关危险因素可以预防或延缓重症急性胰腺炎患者急性肾损伤的发生。目的 系统分析重症急性胰腺炎患者发生急性肾损伤的危险因素。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普网（CQVIP）和中国生物医学文献服务系统（SinoMed）中关于重症急性胰腺炎患者发生急性肾损伤危险因素的文献，检索时限均为建库至2022年1月。由两名研究者按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.4和Stata 15.1软件进行Meta分析。结果 共纳入21篇文献，总病例数为3 823例。Meta分析结果显示，男性〔OR=1.42，95%CI（1.21，1.68），P＜0.001〕，有饮酒史〔OR=1.51，95%CI（1.14，2.01），P=0.004〕，急性生理与慢性健康（APACHE Ⅱ）评分〔MD=5.69，95%CI（2.95，8.44），P＜0.001〕、Ranson评分〔MD=2.58，95%CI（2.27，2.88），P＜0.001〕、CT严重指数（CTSI）评分〔MD=1.48，95%CI（0.17，2.80），P=0.030〕高，白细胞计数〔MD=0.96，95%CI（0.47，1.44），P＜0.001〕、白介素33（IL-33）〔MD=28.36，95%CI（19.05，37.67），P＜0.001〕、C反应蛋白（CRP）〔MD=17.38，95%CI（12.39，22.38），P＜0.001〕、血肌酐（Scr）〔MD=49.50，95%CI（24.80，74.19），P＜0.001〕、降钙素原（PCT）〔MD=6.74，95%CI（3.36，10.12），P＜0.001〕、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）〔MD=18.31，95%CI（11.82，24.80），P＜0.001〕、乳酸〔MD=0.87，95%CI（0.27，1.46），P=0.004〕水平升高，合并低氧血症〔OR=9.42，95%CI（4.81，18.44），P＜0.001〕、高血压〔OR=1.35，95%CI（1.06，1.72），P=0.010〕、糖尿病〔OR=1.56，95%CI（1.20，2.04），P＜0.001〕、冠心病〔OR=3.20，95%CI（1.41，7.24），P=0.005〕，采用机械通气〔OR=5.00，95%CI（2.76，9.07），P＜0.001〕，合并休克〔OR=11.60，95%CI（3.37，39.91），P＜0.001〕、感染〔OR=5.78，95%CI（3.10，10.79），P＜0.001〕、多器官功能障碍综合征（MODS）〔OR=7.28，95%CI（3.56，14.88），P＜0.001〕、腹腔出血〔OR=5.51，95%CI（1.38，22.09），P=0.020〕、急性呼吸窘迫综合征（ARDS）〔OR=9.61，95%CI（4.14，22.27），P＜0.001〕、腹腔间室综合征（ACS）〔OR=5.79，95%CI（3.75，8.93），P＜0.001〕，ICU入住时间长〔MD=8.77，95%CI（2.76，14.79），P=0.004〕是重症急性胰腺炎患者发生急性肾损伤的危险因素。结论 男性、有饮酒史，APACHE Ⅱ评分、Ranson评分、CTSI评分高，白细胞计数、IL-33、CRP、Scr、PCT、NGAL等炎性指标增高及乳酸水平升高，合并低氧血症、高血压、糖尿病、冠心病等基础疾病，采用机械通气，合并休克、感染、MODS、腹腔出血、ARDS、ACS，ICU入住时间长可能是重症急性胰腺炎患者发生急性肾损伤的危险因素。临床医护人员应根据这些危险因素，早期识别并干预发生急性肾损伤的高危患者，降低SAP患者并发急性肾损伤的发生率与死亡率。