Comparative assessment of two frailty instruments for risk-stratification in elderly surgical patients: study protocol for a prospective cohort study

Abstract

BackgroundFrailty is an aggregate expression of susceptibility to poor outcomes, owing to age-, and disease-related deficits that accumulate within multiple domains. Older patients who are frail before surgery are at an increased risk of morbidity and mortality, and use a disproportionately high amount of healthcare resources. While frailty is now a well-established risk factor for adverse postoperative outcomes, the perioperative literature lacks studies that: 1) compare the predictive accuracy of different frailty instruments; 2) consider the impact of frailty on patient-reported outcome measures; and 3) consider the acceptability and feasibility of using frailty instruments in clinical practice.MethodsWe will conduct a multicenter prospective cohort study comparing the predictive accuracy of the modified Fried Index (mFI) with the Clinical Frailty Scale (CFS) among consenting patients aged 65 years and older having elective major non-cardiac surgery. The primary outcome will be disability free survival at 90 days after surgery, a patient-reported outcome measure. Secondary outcomes will include complications, length of stay, discharge disposition, readmission and total health system costs. We will compare the accuracy of frailty instruments using the relative true positive rate and relative false positive rate. These measures can be interpreted as the relative difference in the probability of one instrument identifying a true case of death or new disability compared to another instrument, or the relative difference in the probability of one instrument identifying a false case of death or new disability, respectively. We will also assess the acceptability and feasibility of each instrument.DiscussionFrailty is an important prognostic factor in the growing population of older patients having surgery. This study will provide novel findings regarding the choice of an accurate, clinically useable frailty instrument in predicting patient reported outcomes, as well as morbidity, mortality and resource use. These findings will inform current practice and future research.

Relationship between frailty and lower urinary tract symptoms among community‐dwelling adults

“…Few studies have compared the performance of different frailty measurement tools in identifying frail individuals . This study investigated the agreement of three frailty measurement tools (FP, mFI, and FDS) and observed weak agreement (κ = 0.023–0.225) among the frailty measurement tools.…”

“…However, the components of assessment and implications on clinical practice differ between FP (physical and mental disability and weakness) and mFI (accumulation of comorbidities and disorders). Few studies have compared the agreement of different frailty tools in identifying frail individuals . To improve the gap, we developed the frailty discriminant score (FDS) to distinguish frail patients from healthy individuals .…”

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

“…Comprehensive geriatric assessment is the evidence-based process to detect and grade frailty, but is resource-intensive [17]. Ongoing research is trying to improve frailty identification and integrate it into clinical practice for older surgical patients [18], older adults in the emergency department [19] and community-dwelling seniors [20]. …”

Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study

“…This was a multicentre prospective cohort study conducted across three separate hospitals in Ottawa, Ontario, Canada. A protocol has been previously published, 14 and primary early outcomes (death or new disability 90 days after surgery) have been disseminated. 5 A specific protocol for 1-yr analysis was not published.…”

“…The current study was a planned analysis of 365-day follow-up data. 5,14 The three hospitals involved included a community hospital, a regional tertiary cancer referral centre, and a tertiary referral centre for spine, vascular, neurosurgery, and trauma. Recruitment occurred between September 1, 2015 and June 30, 2017.…”