The effects of frailty on quality of recovery and complications in older adults undergoing major abdominal surgery: a prospective cohort study

Abstract

Aims: There is an increase in the number of older people who have undergone surgical intervention in proportion to the aging of the global population. This situation creates the need to adapt surgical care according to the pathophysiological profile of older people. Recently, it has been argued that chronological age alone does not explain biological age, and frailty will be an appropriate parameter in organizing surgical care of older people. This study aimed to determine the effect of frailty on 30-day postoperative complications and quality of recovery in older people undergoing major abdominal surgery.
 Methods: A prospective cohort study was conducted in the General Surgery Department of the Erciyes University Medical Center in Türkiye. Overall, 222 patients aged 65 and over underwent major abdominal surgery between February 2021 and 2023. Frailty was determined using Fried Frailty Index. 30-day postoperative complications were evaluated using the Clavien Dindo Classification. Quality of recovery- 40 (QoR-40) was filled three days after surgery to determine the quality of recovery of the patients. Receiver-operating characteristic curves analysis was used to evaluate the ability to predict 30-day complications of frailty. Univariate linear regression analysis was performed to determine frailty to be an independent predictor of the QoR-40. 
 Results: The majority of the participants were male (56.8%), the mean age was 71.41±5.29 years, and 50% of patients were frail. Frail patients (28.1%) showed a higher rate of major complications compared to non-frail patients (9.3%). The Fried frailty index score significantly predicted 30-day postoperative complications (AUC=0.653, 95%=0.565-0.741). The total mean score of the QoR-40 scale was 147.09±15.82. Univariate linear regression analysis found frailty (OR -3.81, 95% CI -4.79- -2,83), age (OR -0,46, 95% CI -0,79- -0,12), Charlson comorbidity index (OR -2,40, 95% CI -3,23- -1,57), and operation time (OR -0,04, 95% CI -0,06- -0,02) as independent predictors of quality of recovery. 
 Conclusion: Frailty is a significant predictor for 30-day postoperative complications and quality of recovery in older people undergoing major abdominal surgery.