Comparison of three frailty measures for 90‐day outcomes of elderly patients undergoing elective abdominal surgery

Abstract

Background: To compare the predictive power of three different evaluation methods of frailty for 90-day outcomes of elderly patients undergoing elective abdominal surgery. Methods: A prospective cohort study was conducted with 194 patients and a postoperative follow-up period of 90 days. Preoperative frailty was evaluated using the five-item FRAIL questionnaire, 54-item frailty index (FI), and nine-item Clinical Frailty Scale (CFS). Receiver operating curves were used to compare the predictive ability for 90-day mortality and long-term hospitalization (LTH), and logistic regression was used to calculate odds ratios and 95% confidence intervals. Results: The incidence rates of frailty assessed using FRAIL, FI, and CFS criteria were 43.8%, 32.5% and 36.6%, respectively. The 90-day mortality and LTH of frail patients were significantly higher than those of non-frail patients regardless of which criteria were used. The CFS and FI predicted 90-day mortality better than FRAIL (CFS versus FRAIL: P = 0.005; FI versus FRAIL: P = 0.041), and the CFS predicted LTH better than FRAIL (P = 0.032). Conclusions: Patients diagnosed with frailty had significantly higher 90-day mortality and LTH regardless of which criteria were used. The CFS and FI were better predictors of 90-day mortality, and the CFS was a better predictor of LTH.

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

“…The mean age was 74.8 years (6.54), and 49.48% were male. Five studies were from Spain, 23–25,35,38 8 were from the United States, 21,26–31,36 and other studies were from China, 32,37 Canada, 34 Poland, 33 and Italy. 22 The common types of surgery were abdominal, 23,24,26,32 cardiac, 25,33,35 and spinal.…”

“…Reasons for high risk of study attrition bias were due to the lack of information for outcomes, prognostic factor information, and potential impact of subjects for those lost to follow-up. The quality of the evidence as assessed by the GRADE tool (Supplemental Digital Content 4, Table 3, http://links.lww.com/AA/E96) was very low to moderate, with 5 articles being very low, 22,24,29,34,36 10 being low, 21,25,27,29–35,37 and 3 being moderate. 23,26,28…”

“…A total of 18 studies with 4479 participants [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] were included after screening 7800 citations and 85 fulltext articles (Figure 1). An additional 4 studies were found to match our inclusion and exclusion criteria [39][40][41][42] ; however, they were missing necessary data for our analysis (ie, percent frail) [39][40][41] or used the same population as a previously published study.…”

“…27,30,35 Five studies (n = 2084) were pooled for 30-day mortality, and greater frailty was significantly associated with mortality outcomes (OR, 6.62 [95% CI, 2.80-15.61]; P < .01; I 2 = 39.5%; Figure 2A). [21][22][23]32,35 Greater frailty at 6 months in 3 studies (n = 437) was also significantly associated with mortality (OR, 2.97 [95% CI, 1.54-5.72]; P < .01; I 2 = 20%; Figure 2B). 25,35,36 For 1-year mortality, 3 studies (n = 486) were pooled, and frailty based on the FRAIL scale was nonsignificantly associated with an OR of 1.54 (95% CI, 0.91-2.58; P = .11; I 2 = 0%; Figure 2C).…”

How Effective is Frailty and Comprehensive Geriatric Assessment to Predict the Long-Term Mortality After General Surgery?

“…Another study evaluating three different frailty screening methods in patients undergoing elective abdominal surgery found frailty to associated with 90-day mortality. The comparison of non-frail patients with frail patients using the FRAIL scale, Frailty index, and Clinical Frailty Scale revealed significantly higher 90-day mortality in frail patients [29]. The superiority of the present study over these studies is the longer follow-up period and assessment with operative risk scoring systems.…”