Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized

Tan, Kok‐Yang; Kawamura, Yutaka; Tokomitsu, Aika; Tang, Terence

doi:10.1016/j.amjsurg.2011.08.012

Cited by 220 publications

(160 citation statements)

References 20 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…25 Eight studies showed an association between frailty and the development of postoperative complications. 20,21,26,27,31,34,36,37 As with mortality, a wide variety of ORs was reported for the development of complications, likely also due to the variation in surgical population and frailty assessment used. With respect to 30-day postoperative complications, the OR ranged from as low as 1.05 (95% CI 0.94 to 1.17) in older adult abdominal surgical patients 21 to as high as 11.70 in patients undergoing emergency general surgery.…”

Section: Frailty and Perioperative Surgical Outcomesmentioning

confidence: 99%

“…Four studies involved patients having cardiac valve surgery (including transcatheter aortic valve repplacement). 4,[22][23][24] Five studies involved a mix of gastrointestinal surgical patients, [25][26][27] including abdominal 21 and other general surgery patients. 28 Two studies involved vascular surgical patients 29,30 and two involved surgical oncology patients with either gynecological neoplasms 31 or gastric adenocarcinoma.…”

Section: Basic Study Characteristicsmentioning

confidence: 99%

Frailty and perioperative outcomes: a narrative review

Beggs

Sepehri

Szwajcer

et al. 2014

Can J Anesth/J Can Anesth

139

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Background Frailty has no single universally accepted definition or method for assessment. It is commonly defined from a physiological perspective as a disruption of homeostatic mechanisms ultimately leading to a vulnerable state. Numerous scoring indices and assessments exist to assist clinicians in determining the frailty status of a patient. The purpose of this review is to discuss the relationship between frailty and perioperative outcomes in surgical patients. Principal findings We performed a review to determine the association of frailty with perioperative outcomes in patients undergoing a wide variety of surgical procedures. A scoping literature search was performed to capture studies from MEDLINE Ò , EMBASE TM , and CENTRAL (Cochrane), which resulted in locating 175 studies across the three electronic databases. After an article screening process, 19 studies were found that examined frailty and perioperative outcomes. The studies used a range of assessments to determine frailty status and included patients in a variety of surgical fields. Regardless of surgical population and method of frailty assessment, a relationship existed between adverse perioperative outcomes and frailty status. Frail patients undergoing surgical procedures had a higher likelihood than non-frail patients of experiencing mortality, morbidity, complications, increased hospital length of stay, and discharge to an institution. Conclusions Patients undergoing surgery who are deemed frail, regardless of the scoring assessment used, have a higher likelihood of experiencing adverse perioperative outcomes. With the lack of a unified definition for frailty, further research is needed to address which assessment method is most predictive of adverse postoperative outcomes.

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“…Age and frailty, assessed using the Edmonton Frailty Scale, were both found to be independent factors for complications and institutionalisation after surgery in Canada [58]. Frailty (Fried's criteria), but not ASA ≥ 3, among 84 older, medically optimised Singaporeans was associated with postoperative complications [59]. Frailty (Fried's criteria) was associated with increasing complication rates (adjusted odds ratio 2.5, 95% CI 1.1-5.8), length of stay and institutionalisation among 594 patients in Baltimore [60].…”

Section: Peri-operative Implicationsmentioning

confidence: 99%

Patient frailty: the elephant in the operating room

2013

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SummaryFor most surgeons and many anaesthetists, patient frailty is currently the 'elephant in the (operating) room': it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri-operative outcomes. We explore the limitations of 'eyeballing' patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri-operative setting. Quantifying frailty is likely to increase the precision of peri-operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the preoperative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research. (While I can't define it)…I know it when I see it.-Justice Potter Stewart, US Supreme Court Clinicians usually recognise a frail patient, who is often, but not always, elderly. However, at best, we usually quantify frailty in a largely subjective 'end-of-the-bed' or 'eyeball' way [1]. Furthermore, although studies have examined patient factors such as age and ASA physical status and their association with peri-operative complications and mortality [2-4], until very recently, few have examined frailty [5]. Frailty increases vulnerability to stressors, which, in the peri-operative setting, can include the procedure(s), complications and medical care administered.The aims of this paper are to review the emerging science around defining and quantifying frailty, and to examine its associated peri-operative risks. Current evidence suggests that quantifying frailty improves the precision of risk assessment [5]. However, we think that, for most surgeons and many anaesthetists, frailty and its associated risks represent an 'elephant in the (operating) room': it is easy to spot, but is often ignored.

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Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized

Cited by 220 publications

References 20 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Frailty and perioperative outcomes: a narrative review

Patient frailty: the elephant in the operating room

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