Abstract
BackgroundMany assessment tools have been used to identify frail surgical patients. This study was designed to explore the prediction value of the frailty index (FI) for postoperative morbidity in older patients undergoing elective gastrointestinal surgery.MethodsBetween January 2019 and September 2020, we conducted a prospective study in our hospital, and patients aged over 65 years were enrolled. The FI assessment was conducted by two specialist nurses based on the 38-item scale, and patients were considered frail if the FI score was ≥ 0.25. The primary outcome was 30-day postoperative morbidity. Univariable and multivariable analyses were used to find the risk factors related to postoperative morbidity.ResultsA total of 246 consecutive patients were enrolled, for whom the median age was 72.0 [interquartile range (IQR): 67.0–77.0] years old, and 175 (71.1%) were male. Of these, 47 (19.1%) were frail. Patients with frailty were associated with older age (p < 0.001), higher American Society of Anesthesiologists (ASA) grade (p = 0.006), lower body mass index (p = 0.001), lower albumin (p = 0.003) and haemoglobin (p < 0.001) levels, increased blood loss (p = 0.034), increased risk of postoperative morbidity (p < 0.001), increased median length of stay (p = 0.017), and increased median postoperative hospital stay (p = 0.003). Multivariable analysis revealed that ASA grade [odds ratio (OR): 2.59, 95% confidence interval (CI) 1.19–5.64, p = 0.016], FI score (OR 7.68, 95% CI 3.19–18.48, p < 0.001) and surgical complexity (OR 22.83, 95% CI 5.46–95.51, p < 0.001) were independent predictors of 30-day postoperative morbidity. However, for patients with major surgery, FI score was the only independent predictor (OR 8.67, 95% CI 3.23–23.25, p < 0.001).ConclusionFrailty was associated with adverse perioperative outcomes, and the 38-item FI scale was a useful frailty screening tool for older patients undergoing elective gastrointestinal surgery. For patients with major surgery, frailty was a more reliable predictor of postoperative 30-day morbidity than age and ASA grade.
Highlights
Surgical treatment for older patients is increasingly prevalent as the older population is growing at an unprecedented rate
Parameters measurement and frailty assessment Scale proposed by Searle SD et al and modified by Munster et al was used for frailty index (FI) assessment, which included 38 items consisting of activities of daily living (ADL), comorbidity, physical, psychological, social, and cognitive items (Additional file 1: Table S1) [18, 19]
Baseline characteristics and clinical outcomes A total of 276 patients were screened for eligibility, and 246 consecutive patients aged over 65 years were included in the analysis (Fig. 1)
Summary
Surgical treatment for older patients is increasingly prevalent as the older population is growing at an unprecedented rate. According to a systematic review of 70 studies, the prevalence of frailty in the older people. The older patients living with frailty have limited physiological reserve, are susceptible to surgical stress. 25% to 50% postoperative adverse outcomes in older people were resulted from the concomitant frailty [4]. It is increasingly important to assess the functional status and screen for frailty for older patients before surgery, because evidence for preoperative optimization showed prehabilitation and other modalities could improve the patients’ reserve to cope with the stress of surgery [14]. This study was designed to explore the prediction value of the frailty index (FI) for postoperative morbidity in older patients undergoing elective gastrointestinal surgery
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