Frailty as a Predictor of Surgical Outcomes in Older Patients

Makary, Martin A.; Segev, Dorry L.; Pronovost, Peter J.; Syin, Dora; Bandeen‐Roche, Karen; Patel, Palak; Takenaga, Ryan K.; Devgan, Lara; Holzmueller, Christine G.; Tian, Jing; Fried, Linda P.

doi:10.1016/j.jamcollsurg.2010.01.028

Cited by 1,787 publications

(1,367 citation statements)

References 31 publications

Supporting

Mentioning

1,268

Contrasting

Unclassified

Order By: Relevance

“…This frailty‐age interaction has otherwise not been well defined in the literature. Frailty has traditionally been described as a syndrome of elderly people 45. In our study, the presence of frailty‐defining diagnoses was a stronger predictor of mortality in younger patients.…”

Section: Discussionsupporting

confidence: 52%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

View full text Add to dashboard Cite

BackgroundFrailty is increasing in prevalence and poses a formidable challenge for clinicians. The cardiac surgery literature consists primarily of small single‐center studies with limited follow‐up, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.Methods and ResultsWe conducted a population‐based, retrospective, cohort study in Ontario, Canada, between 2008 and 2015. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator (a multidimensional instrument validated for research using administrative data). The primary outcome was mortality. Mortality rates were calculated using the Kaplan‐Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. Of 40 083 patients, 8803 (22%) were frail. At 4±2 years of follow‐up, age‐ and sex‐standardized mortality rate per 1000 person‐years was higher in frail (33; 95% confidence interval, 29–36) compared with nonfrail (22; 95% confidence interval, 19–24) patients. Frailty was associated with an increased risk of long‐term mortality (adjusted hazard ratio, 1.20; 95% confidence interval, 1.12–1.28) and greater differences in the survival of patients between 40 and 74 years of age than in those who were ≥85 years old.ConclusionsFrailty was present in a large proportion of patients undergoing coronary artery bypass grafting and was independently associated with long‐term mortality. The adjusted risk of frailty‐related death was inversely proportional to age. Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates. In addition, we identified the <75 years age group as a potential target for comprehensive preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation, and psychosocial support.

show abstract

Section: Discussionsupporting

confidence: 52%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…The study design varied and included twenty-two prospective studies, two retrospective studies and one cross-sectional study. Five of the included studies were sub-group analyses of larger studies (27)(28)(29)(30)(31). Several studies reported findings for more than one outcome (10,24,30,32,33).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…This variation was supported by the other reported studies of POD in this review. For example, the highest incidence of delirium occurred in patients undergoing abdominal surgery (24-51%) (32,(38)(39)(40) compared to those undergoing orthopaedic (10-28%) (37,(41)(42)(43)(44) or urological procedures (2-9%) (28,35).…”

Section: Deliriummentioning

confidence: 99%

“…Recent studies have reported a high prevalence of frailty in older surgical patients and identified that pre-operative frailty is an important predictor of poor discharge outcomes including longer hospital stays and the need for higher levels of care (24,25). However, there is limited evidence supporting interventions to improve discharge outcomes (26)(27)(28)(29). There is a clear need to understand the risk of geriatric syndromes and the relationship between frailty, geriatric syndromes and outcomes in both elective and non-elective older surgical ward patients in order to design intervention studies to improve these outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Understanding the occurrence of geriatric syndromes in older surgical patients

McRae¹

View full text Add to dashboard Cite

The population is ageing and surgery is becoming more common as the treatment of choice for many diseases and conditions in older people. Although mortality rates are low for many operations, older patients are at increased risk of complications and may have poor outcomes including longer hospital stays and discharge to sub-acute care or aged care facilities.The aim of this thesis was to describe the occurrence of non-disease specific complications, known as geriatric syndromes, in older patients admitted to surgical wards, and to explore the association of 'frailty' and other key risk factors with geriatric syndromes and discharge outcomes in order to identify high risk groups who might benefit from interventions designed to prevent these complications and improve discharge outcomes.The specific aims were to:1. Describe the occurrence of geriatric syndromes in older surgical ward patients (with the exception of hip fracture or cardiothoracic patients) 2. Investigate the association between key risk factors for geriatric syndromes and discharge outcomes (acute length of stay and discharge destination) in older surgical ward patients.A literature review of the occurrence of geriatric syndromes in the broader surgical population cared for in usual care wards is presented in Chapter 2(1).The occurrence of geriatric syndromes in older patients admitted under two surgical subspecialty units is presented in Chapter 3 (2). In this retrospective cohort study of 112 patients aged 65, admitted under the urology or vascular surgical units of Royal Brisbane and Women's Hospital for three days or more, we found that geriatric syndromes occurred in 32 % of patients. We examined the association of pre-existing impairment in activities of daily living (a unidimensional marker of frailty), mode of admission (elective versus non-elective), extent of surgery (non-operative, minor, major) and surgical sub-specialty unit with ≥1 geriatric syndromes. In multivariable analysis, nonelective admission, major surgery and pre-existing impairment in activities of daily living increased the likelihood of geriatric syndromes. No significant association was seen in the adjusted model with surgical unit, age or comorbidity score.In Chapter 4, we describe the prevalence of frailty and the occurrence of geriatric syndromes in older vascular surgical ward patients and more precisely examine the association of pre-existing II patient factors (frailty and comorbidities), illness severity, surgical severity and mode of admission with ≥1 geriatric syndromes, acute length of stay and discharge destination from the vascular surgical unit. In a prospective cohort study of 110 patients admitted to the vascular surgical unit of Royal Brisbane and Women's Hospital for three days or more, we found that 39% of participants were frail and 36% developed ≥1 geriatric syndromes. In multivariable analysis, this study found multiple risk factors for geriatric syndromes; frailty and non-elective admission were important predictors for both geriatric syndrom...

show abstract

Frailty as a Predictor of Surgical Outcomes in Older Patients

Cited by 1,787 publications

References 31 publications

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

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

Understanding the occurrence of geriatric syndromes in older surgical patients

Contact Info

Product

Resources

About