{"title":"老年外科患者肌肉减少症与术后谵妄的关系：一项系统回顾和荟萃分析。","authors":"Yunying Feng, Ruixiao Sun, Yuelun Zhang, Lulu Ma, Yuguang Huang, Kang Yu","doi":"10.1186/s12877-025-06183-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia, characterized by the progressive loss of muscle mass and strength, is common in the elderly and significantly increases the risk of poor postoperative outcomes. This study aims to examine the impact of sarcopenia on postoperative delirium and a range of perioperative outcomes in elderly patients.</p><p><strong>Methods: </strong>A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL. Studies investigating the association between sarcopenia and postoperative complications in elderly surgical patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included other postoperative complications and further recovery. Subgroup analyses were conducted based on surgery types.</p><p><strong>Results: </strong>A total of 10,981 records were identified, with 265 studies included in the systematic review and 242 in the final meta-analysis. A significant association was found between sarcopenia and postoperative delirium in both univariable and multivariable analyses (univariable: OR 1.81, 95% confidence interval [CI] 1.31 to 2.50, P < 0.001, I<sup>2</sup> 24.0%; multivariable: OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I<sup>2</sup> 0.0%). Sarcopenia was also associated with adverse postoperative outcomes, including increased complications, mortality, delayed recovery, and reduced overall survival. However, no significant associations were observed for postoperative pancreatic fistula or recurrence. Syntheses of multivariable analyses showed significant differences in postoperative complications, mortality, overall survival, and recurrence. Subgroup analyses indicated a higher risk of reduced overall survival among sarcopenic patients undergoing head and neck or heart and chest surgeries.</p><p><strong>Conclusions: </strong>Sarcopenia is a strong independent predictor of postoperative delirium and poor postoperative outcomes in elderly surgical patients.</p><p><strong>Systematic review registration: </strong>PROSPERO registration number CRD42023424696 (18 May 2023).</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":"25 1","pages":"520"},"PeriodicalIF":3.8000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255066/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association between sarcopenia and postoperative delirium in elderly surgical patients: a systematic review and meta-analysis.\",\"authors\":\"Yunying Feng, Ruixiao Sun, Yuelun Zhang, Lulu Ma, Yuguang Huang, Kang Yu\",\"doi\":\"10.1186/s12877-025-06183-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sarcopenia, characterized by the progressive loss of muscle mass and strength, is common in the elderly and significantly increases the risk of poor postoperative outcomes. This study aims to examine the impact of sarcopenia on postoperative delirium and a range of perioperative outcomes in elderly patients.</p><p><strong>Methods: </strong>A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL. Studies investigating the association between sarcopenia and postoperative complications in elderly surgical patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included other postoperative complications and further recovery. Subgroup analyses were conducted based on surgery types.</p><p><strong>Results: </strong>A total of 10,981 records were identified, with 265 studies included in the systematic review and 242 in the final meta-analysis. A significant association was found between sarcopenia and postoperative delirium in both univariable and multivariable analyses (univariable: OR 1.81, 95% confidence interval [CI] 1.31 to 2.50, P < 0.001, I<sup>2</sup> 24.0%; multivariable: OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I<sup>2</sup> 0.0%). Sarcopenia was also associated with adverse postoperative outcomes, including increased complications, mortality, delayed recovery, and reduced overall survival. However, no significant associations were observed for postoperative pancreatic fistula or recurrence. Syntheses of multivariable analyses showed significant differences in postoperative complications, mortality, overall survival, and recurrence. 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引用次数: 0
摘要
背景：肌肉减少症以肌肉质量和力量的逐渐减少为特征，在老年人中很常见，并且显著增加了术后不良预后的风险。本研究旨在探讨肌肉减少症对老年患者术后谵妄及围手术期预后的影响。方法：在MEDLINE、EMBASE、CINAHL和Cochrane CENTRAL中进行系统检索。研究调查老年外科患者肌肉减少症与术后并发症之间的关系。预后质量研究（QUIPS）工具用于偏倚风险评估。主要观察指标是术后谵妄的发生率。次要结果包括其他术后并发症和进一步恢复。根据手术类型进行亚组分析。结果：共纳入10981条记录，系统评价纳入265项研究，最终荟萃分析纳入242项研究。单变量和多变量分析均发现肌肉减少症和术后谵妄之间存在显著关联(单变量：OR 1.81, 95%可信区间[CI] 1.31 ~ 2.50, P 2.24.0%；多变量：OR 2.42, 95% CI 1.27 ~ 4.59, P = 0.007, I2 0.0%)。肌肉减少症还与术后不良结果相关，包括并发症增加、死亡率、恢复延迟和总生存率降低。然而，未观察到术后胰瘘或复发的显著相关性。综合多变量分析显示术后并发症、死亡率、总生存率和复发率有显著差异。亚组分析表明，在接受头颈部或心脏和胸部手术的肌肉减少患者中，总生存期降低的风险更高。结论：骨骼肌减少症是老年外科患者术后谵妄和术后不良预后的一个强有力的独立预测因素。系统评价注册：PROSPERO注册号CRD42023424696（2023年5月18日）。
Association between sarcopenia and postoperative delirium in elderly surgical patients: a systematic review and meta-analysis.
Background: Sarcopenia, characterized by the progressive loss of muscle mass and strength, is common in the elderly and significantly increases the risk of poor postoperative outcomes. This study aims to examine the impact of sarcopenia on postoperative delirium and a range of perioperative outcomes in elderly patients.
Methods: A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL. Studies investigating the association between sarcopenia and postoperative complications in elderly surgical patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included other postoperative complications and further recovery. Subgroup analyses were conducted based on surgery types.
Results: A total of 10,981 records were identified, with 265 studies included in the systematic review and 242 in the final meta-analysis. A significant association was found between sarcopenia and postoperative delirium in both univariable and multivariable analyses (univariable: OR 1.81, 95% confidence interval [CI] 1.31 to 2.50, P < 0.001, I2 24.0%; multivariable: OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I2 0.0%). Sarcopenia was also associated with adverse postoperative outcomes, including increased complications, mortality, delayed recovery, and reduced overall survival. However, no significant associations were observed for postoperative pancreatic fistula or recurrence. Syntheses of multivariable analyses showed significant differences in postoperative complications, mortality, overall survival, and recurrence. Subgroup analyses indicated a higher risk of reduced overall survival among sarcopenic patients undergoing head and neck or heart and chest surgeries.
Conclusions: Sarcopenia is a strong independent predictor of postoperative delirium and poor postoperative outcomes in elderly surgical patients.
Systematic review registration: PROSPERO registration number CRD42023424696 (18 May 2023).
期刊介绍：
BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
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