Background The decision as to whether a patient can tolerate surgery is often subjective and can misjudge a patient's true physiologic state. The concept of frailty is an important assessment tool in ...the geriatric medical population, but has only recently gained attention in surgical patients. Frailty potentially represents a measureable phenotype, which, if quantified with a standardized protocol, could reliably estimate the risk of adverse surgical outcomes. Study Design Frailty was prospectively evaluated in the clinic setting in patients consenting for major general, oncologic, and urologic procedures. Evaluation included an established assessment tool (Hopkins Frailty Score), self-administered questionnaires, clinical assessment of performance status, and biochemical measures. Primary outcome was 30-day postoperative complications. Results There were189 patients evaluated: 117 from urology, 52 from surgical oncology, and 20 from general surgery clinics. Mean age was 62 years, 59.8% were male, and 71.4% were Caucasian. Patients who scored intermediately frail or frail on the Hopkins Frailty Score were more likely to experience postoperative complications (odds ratio OR 2.07, 95% CI 1.05 to 4.08, p = 0.036). Of all other preoperative assessment tools, only higher hemoglobin (p = 0.033) had a significant association and was protective for 30-day complications. Conclusions The aggregate score of patients as “intermediately frail or frail” on the Hopkins Frailty Score was predictive of a patient experiencing a postoperative complication. This preoperative assessment tool may prove beneficial when weighing the risks and benefits of surgery, allowing objective data to guide surgical decision-making and patient counseling.
Abstract Background Frailty is an objective measurement capable of preoperatively identifying patients with increased risk of 30-day morbidity and mortality, though less is known about its utility ...beyond that timeframe. We hypothesized that preoperative frailty is associated with an increased risk of one-year mortality in patients undergoing major intra-abdominal surgery. Materials and Methods Demographics, laboratory values, and traditional surgical risk assessments (American Society of Anesthesiologists scale, Eastern Cooperative Oncology Group Performance Status, Charlson Comorbidity Index) were collected prospectively. Preoperative frailty was evaluated using Fried criteria. Postoperative complications were defined by Clavien-Dindo Classification. One-year mortality data was gathered from phone calls, medical records, and the National Death Index. Results This study included 189 patients with a mean age of 62 years. 59.8% were male and 71.4% were Caucasian. At enrollment, 139 (73.5%) patients were considered “not frail”, while 50 (26.5%) were considered “intermediately frail” or “frail”. A total of 73 (38.6%) patients experienced a 30-day postoperative complication. At one year, 15 (7.9%) patients had died, 5 (3.6%) not frail and 10 (20.0%) intermediately frail/frail patients. Postoperative mortality occurred < 30 days, between 31-100 days, and > 100 days in 3, 4, and 8 patients respectively. Malignant neoplasm was documented as the underlying cause of death in 12 patients. All 30-day mortalities occurred in frail patients who had a postoperative complication. Conclusions Frailty status is predictive of one-year postoperative mortality. The Fried Frailty Criteria has the potential to more accurately evaluate surgical patients’ mortality risk beyond the immediate postoperative period, particularly when considered collectively with traditional surgical risk assessment tools.
