Abstract
BackgroundFrailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk.ObjectiveThis study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines.DesignRetrospective observational analysis.SettingSingle center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017.PatientsPatients 65 years old or older were evaluated for frailty using Fried’s 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria) and frail (3–5 positive criteria) groups.Main outcome measuresThe incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed.ResultsFrom 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04–3.05) and frail (OR 2.08; 95% CI 1.21–3.60) patients.ConclusionsThe preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification.
Highlights
The concept of frailty and its relevance in the perioperative setting has been increasingly recognized in recent years [1,2,3,4,5]
After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail and frail patients
The preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk
Summary
The concept of frailty and its relevance in the perioperative setting has been increasingly recognized in recent years [1,2,3,4,5]. Frailty describes a state of reduced physiological reserves, and a limited ability to compensate and recover from stressors. Surgery is often a major stressor, and current preoperative evaluation methods still fail to properly estimate physiological reserves [6]. The routine implementation of a frailty assessment could provide a more comprehensive and individualized perioperative risk stratification [3]. Frailty can affect any age group, but it is more commonly found in older individuals, in combination with comorbidities and functional decline. The prevalence of frailty in the perioperative setting is expected to rise. Frailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk
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