Frailty predicts surgical outcome for older patients, study says

By Allen Cone
Researchers say frailty could be used as a method of identifying older patients who may experience adverse outcomes following surgery. Photo by maxlkt/Pixabay
Researchers say frailty could be used as a method of identifying older patients who may experience adverse outcomes following surgery. Photo by maxlkt/Pixabay

Feb. 20 (UPI) -- Older patients' successful outcomes from surgery, including repeat hospitalizations, are dependent on identifying their frailty, according to research in Canada.

According to research published Tuesday in the Canadian Medical Association Journal, few studies have examined the risk of additional health care associated with frailty in older patients.


"Identifying frailty in surgical patients will help to predict which patients are at high risk of adverse outcomes, thus improving patient and family discussions and targeting patients for enhanced postoperative care," researchers wrote in the study.

"Moreover, the results of this study suggest that poor postoperative prognosis is not limited to the most severely frail patients, but that vulnerable patients without evident disability are also at higher risk of readmission or death after discharge."

Researchers studied 308 patients aged 65 years or older who survived emergency abdominal surgery between January 2014 and September 2015 at two tertiary care hospitals, the University of Alberta Hospital in Edmonton and Foothills Medical Center in Alberta. Fourteen additional patients died before discharge and were excluded from the analyses.

Fifty-five percent of the participants were male and, with a median age of 75, almost three-quarters had been living at home independently.


Using the Canadian Study of Health and Aging Clinical Frailty Scale, 23 percent were classified as "well," 55 percent were "vulnerable" and 22 percent were "frail."

Thirty days after discharges, 16.1 percent of vulnerable patients were readmitted or died compared with 17.6 percent of frail ones.

Six months after discharge, the readmission or death percentage of vulnerable patients was 33.3 percent, 54.4 percent for frail patients and 15.3 percent for well patients.

"Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as six months after discharge," the researchers wrote. "Therefore, the degree of frailty has important prognostic value for readmission."

Researchers said a comprehensive geriatric assessment might help improve outcomes.

"Frailty can also be considered a useful outcome measure," Dr. Olga Theou and Dr. Samuel Searle of Dalhousie University wrote in a separate commentary published with the study. "It is a measure of overall health state and, arguably, a better predictor of adverse health outcomes than other individual health measures, although it is a dynamic process.

"Future research should focus on whether modifying clinical treatment plans can modify level of frailty or enable patients to recover to their level of frailty before surgery and admission to hospital," they wrote.


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