A new study published in the Journal of the American College of Surgeons, noted that frailty, a decline in function and resistance to short-term stress that typically occurs in old age, is linked to more complications after an operation among adults of all ages. The researchers suggest that a brief measure of frailty can help determine a patient’s physical fitness for a nonurgent operation.
Among 14,530 adults undergoing various elective operations in a single healthcare system, those who demonstrated three or more frailty criteria were significantly more likely in the first postoperative month to experience worse results compared with patients without frailty criteria. Specifically, more frail patients had higher rates of major illness or complications, discharge from the hospital to a rehabilitation facility, readmission to the hospital, or death, researchers reported.
“Frailty is identified as an important risk factor affecting surgical outcomes in elderly patients and more recently also in younger patients, even people as young as 40,” said the study’s lead investigator Claire L. Isbell, MD, MSCI, FACS, a general surgeon at Baylor Scott & White Memorial Hospital in Temple, TX. “With the national obesity epidemic, comorbidities [co-occurring illnesses] typically seen later in life are increasingly prevalent in younger people.”
This study is the first to determine the impact of frailty on postoperative outcomes in multiple surgical subspecialties across a large health care system for both inpatient and outpatient procedures, said coinvestigator Harry T. Papaconstantinou, MD, FACS, chairman of the department of surgery at Baylor Scott & White Memorial Hospital.
Nearly 30 percent of the 14,530 operations studied at Baylor Scott & White Health’s four hospitals were general surgical procedures. Others included urology, plastic surgery, ear-nose-throat, podiatry, cancer, heart and lung, colorectal, transplant, vascular, and oral and maxillofacial procedures. About 68 percent of the operations were outpatient and 32 percent were inpatient procedures.
Compared with low frailty, the presence of high frailty correlated with significantly worse outcomes within 30 days of the operation including:
- Increased risk of experiencing a major complication (a composite of multiple serious complications): 2.9 and 1.8 times greater odds in the outpatient and inpatient groups, respectively
- Longer median hospital stay, by 2.5 days; higher healthcare costs; and a 5.6 times greater chance of being discharged to a nursing facility for the inpatient group
- Greater chance of being readmitted to the hospital: 4.8 times the odds for outpatients and 2.3 times the odds for inpatients
- More than twice the odds of an emergency room visit after an outpatient procedure
Even intermediate, or moderate, frailty significantly increased the risk of all these outcomes, the researchers reported.
Frailty evaluation has the potential to be a risk stratification tool for surgeons and their patients, according to the study authors. Measurement of frailty is available through multiple scoring classifications, but it is not yet widely accepted for hospitals to measure frailty preoperatively, Dr. Papaconstantinou said. He said their large health system is measuring frailty before surgical procedures in an attempt to improve outcomes by identifying at-risk patients and then using risk mitigation strategies, such as exercise, nutrition, and medication management.
