Acute postoperative frailty.

摘要

We read with great interest the article by Dr Wolfe concerning the influence of surgical stress on muscle mass in the elderly. The author underlines that the catabolic response to stress is of even greater concern in the elderly, because of the limited muscle mass of many older people before injury and operation. Wolfe also suggests that hormonal therapy together with nutritional supplementation and exercise can represent a possible strategy to prevent the catabolic response and improve physical function after operation.We agree with the author. But some additional issues need to be addressed. A major focus of research in clinical geriatrics is frailty syndrome, a clinical entity characterized by a vicious cycle in which sarcopenia plays a central role. Hormonal dysregulation (decline in anabolic hormones and increase in catabolic hormones) and inflammation (increased levels of inflammatory cytokines),often through a synergistic interaction, are important pathways to frailty. Several authors have proposed that frailty becomes clinically evident at the time of acute stress.