Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines - a retrospective observational study.
Elderly
Frailty
Outcome
Perioperative
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
07 11 2019
07 11 2019
Historique:
received:
30
06
2019
accepted:
28
10
2019
entrez:
9
11
2019
pubmed:
9
11
2019
medline:
25
9
2020
Statut:
epublish
Résumé
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. This study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines. Retrospective observational analysis. Single center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017. Patients 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. The 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. From 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. 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. 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.
Sections du résumé
BACKGROUND
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.
OBJECTIVE
This study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines.
DESIGN
Retrospective observational analysis.
SETTING
Single center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017.
PATIENTS
Patients 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 MEASURES
The 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.
RESULTS
From 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.
CONCLUSIONS
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. 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.
Identifiants
pubmed: 31699033
doi: 10.1186/s12871-019-0880-x
pii: 10.1186/s12871-019-0880-x
pmc: PMC6839249
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
204Références
JAMA Surg. 2014 Nov;149(11):1191-7
pubmed: 25230137
J Am Geriatr Soc. 2012 Aug;60(8):1487-92
pubmed: 22881367
Ann Surg. 1998 Oct;228(4):491-507
pubmed: 9790339
Can J Anaesth. 2013 Sep;60(9):881-7
pubmed: 23857041
Ann Surg. 2011 Jun;253(6):1223-9
pubmed: 21412145
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
J Endourol. 2014 Apr;28(4):476-80
pubmed: 24308497
J Arthroplasty. 2019 Jul;34(7):1412-1416
pubmed: 30930155
Arch Gerontol Geriatr. 2015 Nov-Dec;61(3):309-21
pubmed: 26272286
Ageing Res Rev. 2016 Mar;26:53-61
pubmed: 26674984
Eur J Anaesthesiol. 2014 Oct;31(10):517-73
pubmed: 25127426
J Am Geriatr Soc. 2014 Feb;62(2):261-8
pubmed: 24437990
BJU Int. 2016 May;117(5):836-42
pubmed: 26691588
BMC Geriatr. 2016 Aug 31;16(1):157
pubmed: 27580947
Arch Gerontol Geriatr. 2009 Jan-Feb;48(1):78-83
pubmed: 18068828
Anasthesiol Intensivmed Notfallmed Schmerzther. 2017 Nov;52(11-12):765-776
pubmed: 29156481
J Am Coll Surg. 2010 Jun;210(6):901-8
pubmed: 20510798
JAMA Netw Open. 2019 May 3;2(5):e194330
pubmed: 31125103
J Am Coll Surg. 2011 Jul;213(1):37-42; discussion 42-4
pubmed: 21435921
Am J Surg. 2015 Feb;209(2):254-9
pubmed: 25173599
Circulation. 2010 Mar 2;121(8):973-8
pubmed: 20159833
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
Am J Epidemiol. 1997 Jun 1;145(11):977-86
pubmed: 9169906
Anasthesiol Intensivmed Notfallmed Schmerzther. 2017 Nov;52(11-12):785-797
pubmed: 29156482
Crit Rev Oncol Hematol. 2010 Dec;76(3):208-17
pubmed: 20005123
JAMA Surg. 2017 Aug 1;152(8):749-757
pubmed: 28467535
Am J Surg. 2013 Oct;206(4):544-50
pubmed: 23880071
Curr Opin Anaesthesiol. 2014 Jun;27(3):330-5
pubmed: 24566452
J Clin Epidemiol. 1994 Nov;47(11):1245-51
pubmed: 7722560
Acta Anaesthesiol Scand. 2016 Mar;60(3):289-334
pubmed: 26514824