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

McIsaac, Daniel I.; Taljaard, Monica; Bryson, Gregory L.; Beaulé, Paul E.; Gagne, Sylvain; Hamilton, Gavin M.; Hladkowicz, Emily; Huang, Allen; Joanisse, John; Lavallée, Luke T.; MacDonald, David B.; Moloo, Husein; Thavorn, Kednapa; Walraven, Carl van; Yang, Homer; Forster, Alan J.

doi:10.1016/j.bja.2020.07.003

Cited by 38 publications

(25 citation statements)

References 35 publications

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“…Several factors may underpin this finding, yet the most likely explanation is that despite surviving the acute phase of critical illness, frail patients ultimately reach a point of exhaustion of their functional reserves and deteriorate as a result of the initial stressor. It needs to be highlighted that despite not finding a clear association between lower CFS scores and mortality, it is reasonable to believe that patients with wild milder frailty fare worse in terms of functional outcomes and quality of life in long-term observation after being admitted to the ICU [ 22 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Jung¹,

Beil²,

Rhodes³

et al. 2021

Crit Care

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Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

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Section: Discussionmentioning

confidence: 99%

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Jung¹,

Beil²,

Rhodes³

et al. 2021

Crit Care

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“…Frailty is defined by CFS score of 4 or more. 42 We will use joint modelling to examine repeated WHODAS scores over the postoperative assessments at 1, 3, 6, 9 and 12 months after surgery, while accounting for non-random participant attrition related to deaths during the same follow-up period. 43 Model covariates will include preoperative WHODAS score, age, sex, surgery type, comorbidities (coronary artery disease, heart failure, cerebrovascular disease, atrial fibrillation, obstructive pulmonary disease, diabetes, liver disease, arthritis, peripheral artery disease, cancer), smoking status and falls history.…”

Section: Event Definitionmentioning

confidence: 99%

Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults

et al. 2022

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IntroductionOlder adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults.Methods and analysisThe Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants’ level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability.Ethics and disseminationThe FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024.

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“…Surgery in frail patients is associated with an initial increase in disability, but a net decrease in long-term disability. 25 As such, social circumstances and support networks should be identified with a view to recognising how this may potentially change after surgery. Family and social support networks should be explored, and patients should be counselled about the potential risk of requiring additional help, which may involve a period of institutionalisation.…”

Section: Functional Social and Environmental Assessmentsmentioning

confidence: 99%

Preoperative assessment of the older patient

2021

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

Cited by 38 publications

References 35 publications

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults

Preoperative assessment of the older patient

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