Clinical Science
Simple frailty score predicts postoperative complications across surgical specialties

Presented as a scientific paper at the American College of Surgeons, October 26, 2011, Chicago, IL.
https://doi.org/10.1016/j.amjsurg.2013.03.012Get rights and content

Abstract

Background

Our purpose was to determine the relationship between preoperative frailty and the occurrence of postoperative complications after colorectal and cardiac operations.

Methods

Patients 65 years or older undergoing elective colorectal or cardiac surgery were enrolled. Seven baseline frailty traits were measured preoperatively: Katz score less than or equal to 5, Timed Up and Go test greater than or equal to 15 seconds, Charlson Index greater than or equal to 3, anemia less than 35%, Mini-Cog score less than or equal to 3, albumin less than 3.4 g/dL, and 1 or more falls within 6 months. Patients were categorized by the number of positive traits as follows: nonfrail: 0 to 1 traits, prefrail: 2 to 3 traits, and frail: 4 or more traits.

Results

Two hundred one subjects (age 74 ± 6 years) were studied. Preoperative frailty was associated with increased postoperative complications after colorectal (nonfrail: 21%, prefrail: 40%, frail: 58%; P = .016) and cardiac operations (nonfrail: 17%, prefrail: 28%, frail: 56%; P < .001). This finding in both groups was independent of advancing age. Frail individuals in both groups had longer hospital stays and higher 30-day readmission rates. Receiver operating characteristic curves examining frailty's ability to forecast complications were colorectal (.702, P = .004) and cardiac (.711, P < .001).

Conclusions

A simple preoperative frailty score defines older adults at higher risk for postoperative complications across surgical specialties.

Section snippets

Methods

This was a prospective cohort study performed at the Denver Veterans Affairs Medical Center, Denver, CO. Regulatory approval was obtained through the Colorado Multiple Institutional Review Board (COMIRB 08-1071). Inclusion criteria were patients 65 years or older undergoing elective colorectal or cardiac operations. Elective cardiac and colon operations were studied because these are 2 common operations performed at our institution that require inpatient stays and are complex enough operations

Results

A total of 201 subjects were studied with an average age of 74 ± 6 years, and 196 (98%) were men. Colorectal operations were performed in 72 (36%) and cardiac operations in 129 (64%) of the total group. A list of operations performed for the colorectal group included the following: 26 (36%) right colectomies, 16 (22%) left colectomies, 22 (31%) sigmoid colectomies, and 8 (11%) colostomy takedowns. A list of operations performed in the cardiac group included 75 (58%) coronary artery bypass

Comments

Although the concept that frailty results in adverse health care events in community-dwelling older adults is well established,19, 20 the notion that frailty can forecast adverse postoperative events in older adults is relatively new. Using a frailty score to risk stratify surgical patients represents a paradigm shift from the current preoperative risk assessment strategy. Frailty measurements were collected by both preanesthesia nurse practitioners and a research assistant who were trained in

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  • Cited by (0)

    Supported by the Paul B. Beeson Award (NIA K23AG034632 [TNR]), Dennis W. Jahnigen Award, American Geriatrics Society (TNR) and National Institutes of Health (K24-HL-089223 [MM]).

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