Beyond Frailty Phenotype, the role of Preoperative Electronic Frailty Assessment in Predicting Postoperative Outcomes in Older Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review

Abstract

Background: Frailty evaluation adds valuable information to standard preoperative risk assessments, however defining frailty in the perioperative period can be challenging. This systematic review examines the role of preoperative electronic frailty assessment in predicting postoperative outcomes in older patients undergoing surgery for gastrointestinal cancer. Methods: A comprehensive search was conducted to identify studies reporting the use of e-frailty screening tools or measures in this population. Studies were assessed for quality and findings were synthesized to determine the prevalence of frailty, outcomes of interest (e.g., length of stay, 30-day mortality), and feasibility of electronic frailty assessment in this setting. Results: A total of 31 studies were included in the review. The studies found that frailty assessments performed using electronic data provided prognostic value for postoperative outcomes. Specifically, among the included studies, 7 were performed prospectively and 24 were conducted retrospectively. The methods of assessing frailty were highly heterogeneous, with frailty being defined using 10 different variables. The most commonly used instruments were the Clinical Frailty Scale (CFS), followed by the 11 item-modified frailty index (mFI-11) and the mFI-5. Reported rates of frailty varied widely, ranging from 2.63% to 61.28%. Feasibility was assessed in all studies, with implementation being the most frequently reported measure. However, only 4 out of 31 data points were based on objective data, and information about other feasibility aspects, such as time needed for completion/speed and practicality, was hardly reported. Conclusions: The findings suggest that electronic frailty assessment can provide valuable information to standard preoperative risk assessments and may help to detect and prevent undesirable postoperative outcomes in this population. Further research is needed to optimize care plans and improve outcomes for older patients undergoing oncologic surgery.