Investigation of the Effect of Frailty Levels of Elderly Patients on their Recovery Status after General Surgery

Abstract

Aim/Objective: The level of frailty increases in the elderly population. It is known that preoperative frailty may cause negative consequences in the postoperative period. This study aimed to determine the effect of preoperative frailty level on postoperative recovery of elderly patients undergoing surgery in general surgery clinics. Material and Method: The research is descriptive - cross-sectional type. The study was conducted between September 1 Eylül, 2021, and October 31, 2022. The study population consisted of 242 patients aged 65 and over who underwent surgery in the General Surgery Clinic. The study sample consisted of 97 patients selected by random sampling method. "Patient Information Form," "Edmonton Frail Scale (EFS)," and "Postoperative Recovery Index (PoRI)" were used for data collection. Data were collected in 3 stages: preoperatively, postoperatively, and after discharge. In the first stage, patient information form and EFS were applied in the preoperative period. In the second stage, PoRI was performed between 24-48 hours in the postoperative period. In the third stage, the PoRI was re-administered at the time of the patient's first visit to the outpatient clinic (on average 1-2 weeks later). Face-to-face and telephone interviews were used to collect the data. Data were evaluated in the IBM Statistics (SPSS) 25.0 program. Quantitative data in the study were shown as number, percentage, mean, and standard deviation values. Kolmogorov Smirnov test, One-Way ANOVA, Mann-Whitney U test, Kruskal Wallis test, and Shapiro Wilk test were applied when necessary. Cronbach's Alpha value was 0.784 for the Edmonton Frailty Scale, and the Postoperative Recovery Index was 0.950 in the first and 0.941 in the second measurement. All ethical permissions were obtained. Results: The mean age of the patients included in the study was 70.82 6.47 years. It was found that 54.7% of the patients were male, and 90.3% were not working. In the Edmonton Frail Scale's measurements, approximately 73.1% of the elderly patients were found to be frail, although their level was different. In the study, PoRI mean1 = 2.9 0.99 in the first 48 hours and PoRI mean2 = 2.0 0.74 in the post-discharge control time. There is a significant difference between EFS and PoRI- 1st and EFS and PoRI- 2nd measurements. It was found that patients with higher mean EFS had more difficulty in recovery. As the patients' frailty level increased, difficulties were identified in improving psychological, physical, nutritional, and general symptoms. When EFS and sociodemographic characteristics were compared, it was observed that elderly individuals with low income had higher rates of frailty. Conclusion: Research results show that the level of frailty present before surgery delays recovery in the postoperative period. Patients aged 65 years and older also have a significantly high level of frailty. In this context, it would be appropriate to conduct frailty screening with measurement tools to determine the level of frailty in the preoperative period for elderly patients and to evaluate the care to be applied accordingly. In this way, frailty, an inhibiting factor in front of recovery, can be managed and will constitute evidence for objective consideration.