Desenlaces negativos y mortalidad en el anciano frágil sometido a cirugía mayor: ¿qué factores de riesgo impactan más?

Autores/as

DOI:

https://doi.org/10.24265/horizmed.2023.v23n3.12

Palabras clave:

Mortalidad, Anciano, Procedimientos Quirúrgicos Operativos; Factores de Riesgo, factores de riesgo

Resumen

El adulto mayor, con frecuencia frágil, es un paciente susceptible a un sinnúmero de complicaciones, tanto inmediatas como a corto, mediano y largo plazo, posterior a una intervención quirúrgica. En función de las comorbilidades presentadas, se debe hacer un abordaje integral para alcanzar el mejor estado orgánico previo a la cirugía e intentar mantenerlo
durante y posterior a la intervención. Considerar la fuerza estadística de los desenlaces negativos y, específicamente, dela mortalidad en adultos mayores sometidos a cirugía mayor, es verdaderamente un reto. Incluso, esto trasciende a otros
campos como la bioética, al plantearse un dilema sobre la distanasia, cuando se recurre a ciertas intervenciones riesgosas
en aquellos con un pronóstico de vida temeroso. Recientemente, se ha publicado evidencia interesante que ha estimado la incidencia, riesgo de mortalidad y factores asociados a desenlaces negativos en adultos mayores sometidos a cirugía mayor, planteando posibles modificaciones en los algoritmos de toma de decisiones en futuras guías de práctica clínica en cirugía. El objetivo de esta revisión consiste en analizar evidencia actualizada sobre qué factores de riesgo impactarían más sobre
desenlaces negativos y mortalidad en el adulto mayor sometido a cirugía mayor. Se realizó una búsqueda bibliográfica utilizando los términos de búsqueda “Cirugía Mayor” y “Adulto Mayor”, además de sinónimos, en las bases de datos PubMed, ScienceDirect, Web of Science y MEDLINE. En cirugía general y subespecialidades, es muy complejo determinar factores de riesgo precisos y extrapolables a todos los escenarios quirúrgicos, debido a la complejidad y especificidad de ciertos órganos y procedimientos. Existe evidencia sobre adultos frágiles que son sometidos a cirugía por cáncer colorrectal, metástasis hepática, cáncer de pulmón, enfermedad pancreática y cáncer esofágico, en donde se registra una mayor estancia hospitalaria; y de forma general, la mortalidad es mayor en aquellos sometidos a cirugía oncológica. No obstante, tanto la integridad física como mental se asocian con peores desenlaces, y la prehabilitación quirúrgica podría impactar de manera positiva sobre esta situación, al mejorar la reserva funcional y tiempo de recuperación posquirúrgico.

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Bickler SN, Weiser TG, Kassebaum N, Higashi H, Chang DC, Barendregt

JJ, et al. Global Burden of Surgical Conditions. In: Disease Control

Priorities, Third Edition (Volume 1): Essential Surgery. The World

Bank; 2015.

Prinja S, Nandi A, Horton S, Levin C, Laxminarayan R. Costs,

effectiveness, and cost-effectiveness of selected surgical procedures

and platforms. In: Disease Control Priorities, Third Edition (Volume

: Essential Surgery. The World Bank; 2015.

Bendix P, Havens JM. The global burden of surgical disease. Curr

Trauma Rep [Internet]. 2017;3(1):25–31.

Powell BL, Luckett R, Bekele A, Chao TE. Sex disparities in the global

burden of surgical disease. World J Surg [Internet]. 2020;44(7):2139–43.

Gajewski J, Brugha R, Bijlmakers L. Global surgery priorities:

A response to recent commentaries. Int J Health Policy Manag

[Internet]. 2019;8(6):381–3.

Quene TM, Bust L, Louw J, Mwandri M, Chu KM. Global surgery

is an essential component of global health. Surgeon [Internet].

;20(1):9–15.

Alsaeed D, Davies N, Gilmartin JFM, Jamieson E, Kharicha K, Liljas

AEM, et al. Older people’s priorities in health and social care

research and practice: a public engagement workshop. Res Involv

Engagem [Internet]. 2016;2(1).

Akishita M, Ishii S, Kojima T, Kozaki K, Kuzuya M, Arai H, et al.

Priorities of health care outcomes for the elderly. J Am Med Dir Assoc

[Internet]. 2013;14(7):479–84.

Hunold KM, Pereira GF, Jones CW, Isaacs CG, Braz VA, Gadi SR, et al.

Priorities of care among older adults in the emergency department: A

cross-sectional study. Acad Emerg Med [Internet]. 2016;23(3):362–5.

World Health Organization. Integrated care for older people:

guidelines on community-level interventions to manage declines in

intrinsic capacity [Internet]. Disponible en: https://www.who.int/

publications/i/item/9789241550109

Newsome K, McKenny M, Elkbuli A. Major and minor surgery: Terms

used for hundreds of years that have yet to be defined. Ann Med Surg

(Lond) [Internet]. 2021;66(102409):102409.

Grounds RM, Rhodes A. Perioperative and intensive care management

of the surgical patient. In: Core Topics in General and Emergency

Surgery. Elsevier; 2014.

Masutani R, Pawar A, Lee H, Weissman JS, Kim DH. Outcomes of

common major surgical procedures in older adults with and without

dementia. JAMA Netw Open [Internet]. 2020;3(7):e2010395.

Becher RD, Vander Wyk B, Leo-Summers L, Desai MM, Gill TM. The

incidence and cumulative risk of major surgery in older persons in

the United States. Ann Surg [Internet]. 2023;277(1):87–92.

Stabenau HF, Becher RD, Gahbauer EA, Leo-Summers L, Allore HG,

Gill TM. Functional trajectories before and after major surgery in

older adults. Ann Surg [Internet]. 2018;268(6):911-7.

Baggett ND, Schulz K, Buffington A, Marka N, Hanlon BM, Zimmermann

C, et al. Surgeon use of shared decision-making for older adults

considering major surgery: A secondary analysis of a randomized

clinical trial. JAMA Surg [Internet]. 2022;157(5):406-13.

Gill TM, Vander Wyk B, Leo-Summers L, Murphy TE, Becher RD.

Population-based estimates of 1-year mortality after major surgery

among community-living older US adults. JAMA Surg [Internet].

;157(12):e225155.

Murad K, Kitzman DW. Frailty and multiple comorbidities in the

elderly patient with heart failure: implications for management.

Heart Fail Rev [Internet]. 2012;17(4–5):581–8.

Díez-Villanueva P, Salamanca J, Rojas A, Alfonso F. Importance

of frailty and comorbidity in elderly patients with severe aortic

stenosis. J Geriatr Cardiol [Internet]. 2017;14(6):379–82.

Van Dam CS, Labuschagne HA, van Keulen K, Kramers C, Kleipool

EE, Hoogendijk EO, et al. Polypharmacy, comorbidity and frailty: a

complex interplay in older patients at the emergency department.

Eur Geriatr Med [Internet]. 2022;13(4):849–57.

Bonaga B, Sánchez-Jurado PM, Martínez-Reig M, Ariza G, RodríguezMañas L, Gnjidic D, et al. Frailty, polypharmacy, and health outcomes

in older adults: The frailty and dependence in Albacete study. J Am

Med Dir Assoc [Internet]. 2018;19(1):46–52.

Fried LP, Cohen AA, Xue QL, Walston J, Bandeen-Roche K, Varadhan

R. The physical frailty syndrome as a transition from homeostatic

symphony to cacophony. Nat Aging [Internet]. 2021;1(1):36–46.

Fulop T, Larbi A, Witkowski JM, McElhaney J, Loeb M, Mitnitski A, et

al. Aging, frailty and age-related diseases. Biogerontology [Internet].

;11(5):547–63.

Cohen AA, Ferrucci L, Fülöp T, Gravel D, Hao N, Kriete A, et al. A

complex systems approach to aging biology. Nat Aging [Internet].

;2(7):580–91.

Pandey A, Kitzman D, Reeves G. Frailty is intertwined with heart

failure: Mechanisms, prevalence, prognosis, assessment, and

management. JACC Heart Fail [Internet]. 2019;7(12):1001–11.

Giallauria F, Di Lorenzo A, Venturini E, Pacileo M, D'Andrea A,

Garofalo U, et al. Frailty in acute and chronic coronary syndrome

patients entering cardiac rehabilitation. J Clin Med [Internet].

;10(8):1696.

Liu P, Li Y, Zhang Y, Mesbah SE, Ji T, Ma L. Frailty and hypertension

in older adults: current understanding and future perspectives.

Hypertens Res [Internet]. 2020;43(12):1352–60.

Pamoukdjian F, Laurent M, Martinez-Tapia C, Rolland Y, Paillaud E,

Canoui-Poitrine F. Frailty parameters, morbidity and mortality in

older adults with cancer: A structural equation modelling approach

based on the fried phenotype. J Clin Med [Internet]. 2020;9(6):1826.

She Q, Chen B, Liu W, Li M, Zhao W, Wu J. Frailty pathogenesis,

assessment, and management in older adults with COVID-19. Front

Med (Lausanne) [Internet]. 2021;8:694367.

Rowe R, Iqbal J, Murali-krishnan R, Sultan A, Orme R, Briffa N,

et al. Role of frailty assessment in patients undergoing cardiac

interventions. Open Heart [Internet]. 2014;1(1):e000033.

Petermann-Rocha F, Pell JP, Celis-Morales C, Ho FK. Frailty,

sarcopenia, cachexia and malnutrition as comorbid conditions and

their associations with mortality: a prospective study from UK

Biobank. J Public Health (Oxf) [Internet]. 2022;44(2):e172–80.

Halle-Smith JM, Naumann DN, Powell SL, Naumann LK, Griffiths

EA. Improving outcomes for elderly patients following emergency

surgery: A cutting-edge review. Curr Anesthesiol Rep [Internet].

;11(4):396–404.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell

I, et al. A global clinical measure of fitness and frailty in elderly

people. CMAJ [Internet]. 2005;173(5):489–95.

Royal College of Anaesthetits. National Emergency Laparotomy Audit

(NELA) [Internet]. Disponible en: https://rcoa.ac.uk/research/

research-projects/national-emergency-laparotomy-audit-nela

Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient:

a review. Age Ageing [Internet]. 2012;41(2):142–7.

Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative

outcomes in older surgical patients: a systematic review. BMC

Geriatr [Internet]. 2016;16(1):157.

Richards SJG, Frizelle FA, Geddes JA, Eglinton TW, Hampton

MB. Frailty in surgical patients. Int J Colorectal Dis [Internet].

;33(12):1657–66.

Sadiq F, Kronzer VL, Wildes TS, McKinnon SL, Sharma A, Helsten DL,

et al. Frailty phenotypes and relations with surgical outcomes: A

latent class analysis. Anesth Analg [Internet]. 2018;127(4):1017–27.

Shem Tov L, Matot I. Frailty and anesthesia. Curr Opin Anaesthesiol

[Internet]. 2017;30(3):409–17.

Yanagawa B, Graham MM, Afilalo J, Hassan A, Arora RC. Frailty as a

risk predictor in cardiac surgery: Beyond the eyeball test. J Thorac

Cardiovasc Surg [Internet]. 2018;156(1):172-176.e2.

Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston

JD. Management of frailty: opportunities, challenges, and future

directions. Lancet [Internet]. 2019;394(10206):1376–86.

Elfrink AKE, Alberga AJ, van Berge Henegouwen MI, Scheurs WH, van

der Geest LGM, Verhagen HJM, et al. Outcomes after major surgical

procedures in octogenarians: A nationwide cohort study. World J Surg

[Internet]. 2022;46(10):2399–408.

Park JK, Kang J, Kim YW, Kim DI, Heo SH, Gil E, et al. Outcomes after

elective open abdominal aortic aneurysm repair in octogenarians

compared to younger patients in Korea. J Korean Med Sci [Internet].

;36(47):e314.

Bufalari A, Giustozzi G, Burattini MF, Servili S, Bussotti C, Lucaroni E,

et al. Rectal cancer surgery in the elderly: a multivariate analysis of

outcome risk factors. J Surg Oncol [Internet]. 2006;93(3):173–80.

Deiner S, Westlake B, Dutton RP. Patterns of surgical care and

complications in elderly adults. J Am Geriatr Soc [Internet].

;62(5):829–35.

Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors,

morbidity, and mortality in elderly patients. J Am Coll Surg

[Internet]. 2006;203(6):865–77.

Pelavski AD, De Miguel M, Alcaraz Garcia-Tejedor G, Villarino L,

Lacasta A, Señas L, et al. Mortality, Geriatric, and Nongeriatric

Surgical Risk Factors Among the Eldest Old: A Prospective

Observational Study. Anesth Analg [Internet]. 2017;125(4):1329–36.

Partridge JS, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK.

Frailty and poor functional status are common in arterial vascular

surgical patients and affect postoperative outcomes. Int J Surg

[Internet]. 2015;18:57–63.

Story DA. Postoperative complications in elderly patients and

their significance for long-term prognosis. Curr Opin Anaesthesiol

[Internet]. 2008;21(3):375–9.

Karageorgos V, Mevorach L, Silvetti M, Bilotta F. Preoperative risk

factors associated with increased incidence of postoperative

delirium: Systematic review of qualified clinical studies. Geriatrics

(Basel) [Internet]. 2023;8(1):24.

Gracie TJ, Caufield-Noll C, Wang NY, Sieber FE. The association of

preoperative frailty and postoperative delirium: A meta-analysis.

Anesth Analg [Internet]. 2021;133(2):314–23.

Watt J, Tricco AC, Talbot-Hamon C, Pham B, Rios P, Grudniewicz A,

et al. Identifying older adults at risk of delirium following elective

surgery: A systematic review and meta-analysis. J Gen Intern Med

[Internet]. 2018;33(4):500–9.

Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel

P, et al. Frailty as a predictor of surgical outcomes in older patients.

J Am Coll Surg [Internet]. 2010;210(6):901–8.

Birkelbach O, Mörgeli R, Spies C, Olbert M, Weiss B, Brauner M, et

al. Routine frailty assessment predicts postoperative complications

in elderly patients across surgical disciplines - a retrospective

observational study. BMC Anesthesiol [Internet]. 2019;19(1):204.

Donald GW, Ghaffarian AA, Isaac F, Kraiss LW, Griffin CL, Smith BK,

et al. Preoperative frailty assessment predicts loss of independence

after vascular surgery. J Vasc Surg [Internet]. 2018;68(5):1382–9.

Watt J, Tricco AC, Talbot-Hamon C, Pham B, Rios P, Grudniewicz

A, et al. Identifying older adults at risk of harm following elective

surgery: a systematic review and meta-analysis. BMC Med [Internet].

;16(1):2.

Hartley P, Gibbins N, Saunders A, Alexander K, Conroy E, Dixon R,

et al. The association between cognitive impairment and functional

outcome in hospitalised older patients: a systematic review and

meta-analysis. Age Ageing [Internet]. 2017;46(4):559-67.

Mayor S. Age is not a risk factor for complications after surgery in

older patients, review finds. BMJ [Internet]. 2018;360:k187.

Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, et al. Risk factors for

postoperative infectious complications in elderly patients with

gastric cancer. Cancer Manag Res [Internet]. 2020;12:4391–8.

Baimas-George M, Watson M, Elhage S, Parala-Metz A, Vrochides

D, Davis BR. Prehabilitation in frail surgical patients: A systematic

review. World J Surg [Internet]. 2020;44(11):3668–78.

Van der Hulst HC, Bastiaannet E, Portielje JEA, van der Bol JM,

Dekker JWT. Can physical prehabilitation prevent complications

after colorectal cancer surgery in frail older patients? Eur J Surg

Oncol [Internet]. 2021;47(11):2830–40.

Carli F, Baldini G. From preoperative assessment to preoperative optimization of frail older patients. Eur J Surg Oncol [Internet].

;47(3):519–23.

Sadlonova M, Katz NB, Jurayj JS, Flores L, Celano CM, von Arnim CAF,

et al. Surgical prehabilitation in older and frail individuals: a scoping

review. Int Anesthesiol Clin [Internet]. 2023;61(2):34–46.

Schaller SJ, Kiselev J, Loidl V, Quentin W, Schmidt K, Mörgeli R, et al.

Prehabilitation of elderly frail or pre-frail patients prior to elective

surgery (PRAEP-GO): study protocol for a randomized, controlled,

outcome assessor-blinded trial. Trials [Internet]. 2022;23(1):468.

Picón Jaimes YA, Orozco Chinome JE, Lozada ID, Moscote Salazar LR.

Enfermedad, eutanasia y aborto: una reflexión desde la bioética.

Rev médica Risaralda [Internet]. 2021;27(1):4-9.

Picón-Jaimes YA, Lozada-Martinez ID, Orozco-Chinome JE, MontañaGómez LM, Bolaño-Romero MP, Moscote-Salazar LR, et al. Euthanasia

and assisted suicide: An in-depth review of relevant historical

aspects. Ann Med Surg (Lond) [Internet]. 2022;75(103380):103380.

Rodríguez Gutiérrez MM, Lozada Martínez ID, Moreno López N, Vargas

Arboleda DA, Nieto García CE, Picón Jaimes YA, et al. Prevalence

of sarcopenia in older adults in two retirement homes in Pereira,

Colombia. Rev Fac Med Humana [Internet]. 2022;22(2):266–72.

Comisión Económica para América Latina y el Caribe. Ageing in Latin

America and the Caribbean: Inclusion and rights of older persons

[Internet]. Disponible en: https://repositorio.cepal.org/bitstream/

handle/11362/48568/4/S2201042_en.pdf

Inter-American Development Bank. Age with Care: Long-term Care in

Latin America and the Caribbean [Internet]. Disponible en: https://

publications.iadb.org/en/age-care-long-term-care-latin-americaand-caribbean

United Nations. Ageing in Latin America and the Caribbean:

implications of past mortality [Internet]. Disponible en:

https://www.un.org/development/desa/pd/sites/www.un.org.

development.desa.pd/files/unpd_egm_200508_09_mceniry.pdf

Lozada-Martinez ID, González-De La Hoz SX, Montaño-Socarras

D, Ovalle-Mulford FJ, Rashid R. Virtual hybrid hotel care model

for the surgical patient: New goal of global academic surgery

to improve global outcomes. Ann Med Surg (Lond) [Internet].

;77(103529):103529.

Nuñez-Gamez JA, Medina-Bravo PA, Piñeros-López NF, Contreras

GA, Rosero-Burgos ME, Lozada-Martínez ID, et al. Global outcomes,

surgical teams and COVID-19 pandemic: Will the same objectives

of global surgery persist? Ann Med Surg (Lond) [Internet].

;71(103002):103002.

Robledo LMG, Cano-Gutiérrez C, Garcia EV. Healthcare for older

people in Central and South America. Age Ageing [Internet].

;51(5).

Ruano AL, Rodríguez D, Rossi PG, Maceira D. Understanding inequities

in health and health systems in Latin America and the Caribbean: a

thematic series. Int J Equity Health [Internet]. 2021;20(1):94.

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Publicado

2023-09-13

Cómo citar

1.
Castillo Muñoz DN, Fernández Bula RC, Guerra Díaz GJ, Ortega Lasso M, Valderrama Matallana LA, Mercado Ortega MC, Torres Osorio EM, Picón Jaimes YA. Desenlaces negativos y mortalidad en el anciano frágil sometido a cirugía mayor: ¿qué factores de riesgo impactan más?. Horiz Med [Internet]. 13 de septiembre de 2023 [citado 22 de febrero de 2024];23(3): e2367. Disponible en: https://www.horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/2367

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