Abstract
BackgroundFrailty is a distinctive health state associated with a loss of physiological reserve that results in higher rates of perioperative complications and impaired return to pre-morbid functional status. It is prevalent in the vascular population; however routine assessment is not common despite national guidance to the contrary. We aimed to evaluate the reliability of the Clinical Frailty Scale in assessing frailty in the surgical vascular population.MethodsIn this prospective, observational, observer-blinded study, we compared assessment of frailty in patients scheduled for major vascular surgery attending the pre-operative assessment clinic using the Clinical Frailty Scale against the Edmonton Frailty Scale.The study investigator completed the Edmonton Frailty Scale assessment; this was compared to the Clinical Frailty Scale assessments performed by the pre-assessment consultant and pre-assessment nurse, who were blinded to the Edmonton Frailty Scale score. The inter-rater reliability of the Clinical Frailty Scale between the pre-assessment consultant and pre-assessment nurse was determined by comparing their frailty scores for each patient.ResultsNinety-seven patients were included in the analysis (median age 72 years, 84% male and 16% female). There was a moderate level of agreement between the Edmonton and Clinical Frailty Scale score for both consultants (87.6% agreement) and pre-assessment nurses (87.6% agreement). There was a substantial level of agreement between consultants and pre-assessment nurses for the Clinical Frailty Scale (89.7% agreement)ConclusionsThe Clinical Frailty Scale is a useful tool to assess frailty in the vascular surgical population. It is more practical than the Edmonton Frailty Scale: quick to complete, requires minimal training and can be used when physical disability is present.Trial registrationThe study was approved by the Wales Health and Care Research Ethics Service (REC reference 17/WA/0160, IRAS 201173). Trial registration: NCT03403673. Registered 19 January 2018, https://clinicaltrials.gov/ct2/show/NCT03403673
Highlights
Frailty is a distinctive health state associated with a loss of physiological reserve that results in higher rates of perioperative complications and impaired return to pre-morbid functional status
Seventy-six of the 97 patients (78%) with full data sets for primary analysis were categorised as non-frail by the reference tool (EFS) (Fig. 2)
The Clinical Frailty Scale (CFS) is a more practical tool compared to the Edmonton Frailty Scale (EFS) for routine pre-operative frailty assessment
Summary
Frailty is a distinctive health state associated with a loss of physiological reserve that results in higher rates of perioperative complications and impaired return to pre-morbid functional status. It is prevalent in the vascular population; routine assessment is not common despite national guidance to the contrary. Patients with three or more features are considered frail, whilst pre-frailty is the stage within the frailty continuum whereby one or two of the Fried’s criteria are met (representing an increased risk of becoming frail) (Han et al, 2019). Individuals who are pre-frail or frail gradually lose their inbuilt physiological reserve, leaving them vulnerable to acute changes in health status triggered by events such as an infection or surgery, resulting in functional decline and prolonged recovery. The pre-frail patient is at higher risk of perioperative complications compared to the non-frail patient (Han et al, 2019)
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