Simple frailty score predicts postoperative complications across surgical specialties

• Published in: The American journal of surgery Vol. 206; no. 4; pp. 544 - 550
• Main Authors: Robinson, Thomas N., Wu, Daniel S., Pointer, Lauren, Dunn, Christina L., Cleveland, Joseph C., Moss, Marc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2013; Elsevier Limited
• Subjects: Aged; Cardiovascular Surgical Procedures; Chronic illnesses; Colon - surgery; Digestive System Surgical Procedures; Female; Frail Elderly; Frailty; Geriatric Assessment; Geriatric surgery; Hospitals; Humans; Length of Stay - statistics & numerical data; Logistic Models; Male; Older people; Patient Readmission - statistics & numerical data; Postoperative Complications; Preoperative risk assessment; Prospective Studies; Rectum - surgery; Risk Assessment; ROC Curve; Surgery; Surgical morbidity; Surgical morbidity; Geriatric surgery; Preoperative risk assessment
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2013.03.012

Our purpose was to determine the relationship between preoperative frailty and the occurrence of postoperative complications after colorectal and cardiac operations. 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. 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). A simple preoperative frailty score defines older adults at higher risk for postoperative complications across surgical specialties.