Abstract
PurposeFrailty is associated with a higher risk for negative postoperative outcomes. This study aimed to determine the association between the screening tool of the Dutch safety management system, Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ and postoperative complications in a gynecological population.MethodsThis cohort study included women aged 70 years or older, who were scheduled for any kind of gynecological surgery. VMS screening data (including risk for delirium, falling, malnutrition, and functional impairment) were extracted from the electronic patient records. VMS score could range between 0 and 4 patients with a VMS score of one or more were considered frail. Data on possible confounding factors and complications within 30 days after surgery, classified with the Clavien–Dindo classification, were collected. Regression analysis was performed.Results157 women were included with a median age of 74 years (inter quartile range 71–79). Most patients underwent prolapse surgery (52%) or hysterectomy (31%). Forty-one patients (26%) experienced any postoperative complication. Sixty-two patients (39%) were considered frail preoperatively by the VMS screening tool. Frailty measured with the VMS screening tool was not independently associated with postoperative complications in multivariable analysis (Odds ratio 1.18; 95% CI 0.49–2.82). However, a recent fall in the last 6 months (n = 208) was associated with postoperative complications (Odds ratio 3.90; 95% CI 1.57–9.66).ConclusionAn independent association between frailty, determined by the VMS screening tool ‘Frail elderly’, and postoperative complications in gynecological surgery patients could not be confirmed. A recent fall in the last 6 months seems associated with postoperative complications.
Highlights
Frailty is an important geriatric syndrome and can be defined as a state of increased vulnerability to negative healthcare outcomes after a stressor event due to reduced reserves and function in several systems [1]
Recent studies in oncological and mixed gynecological populations showed that screening for frailty and adjusting care for frail patients preoperatively can result in better postoperative outcomes [2,3,4, 11]
Frailty was found in 62 patients (39%)
Summary
Frailty is an important geriatric syndrome and can be defined as a state of increased vulnerability to negative healthcare outcomes after a stressor event due to reduced reserves and function in several systems [1]. Frailty is associated with negative healthcare outcomes, such as postoperative complications, functional decline, loss of independence, lower quality of life, and even death [1,2,3,4,5,6]. To determine which patients are at risk for frailty and could benefit from a comprehensive geriatric assessment, multiple frailty screening instruments exist. The 5-item modified frailty index [12] and the 11-item National Surgical Quality Improvement Program Frailty Index (NSQIP-FI) [2, 13] were associated with postoperative complications in patients undergoing surgery for pelvic organ prolapse [12, 13] or hysterectomy for any indication [2]. Dutch hospitals are obliged by rule and legislation (NTA 8009) [14] to use a screening tool to prevent unnecessary functional decline for all admitted patients aged 70 years and older: the safety management system, Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ [15]
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