Frailty as a Predictor of Death or New Disability After Surgery

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:10.1097/sla.0000000000002967

Cited by 139 publications

(117 citation statements)

References 34 publications

Supporting

Mentioning

109

Contrasting

Order By: Relevance

“…2 Its association with poor outcomes has been demonstrated in multiple settings, from the community dwelling population to the surgical population. [3][4][5][6][7][8][9][10] This relationship appears particularly relevant in patients requiring emergent procedures. 11,12 In a recent systematic review of the spine surgery literature, frailty has been demonstrated to affect post-operative outcomes such as adverse events (AEs), mortality, and length of stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

View full text Add to dashboard Cite

Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS ( p = 0.0375), but not of AEs ( p = 0.1428) or in-hospital mortality ( p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

View full text Add to dashboard Cite

show abstract

“…The study by McIsaac et al have suggested that almost all elderly patients are willing to participate in a frailty assessment before going for major surgery. 33 The high value score and low burden score obtained from the QQ-10 data suggested that our patients had a pleasant experience with EFS questionnaire during their preoperative visit and found it as making a positive impact on their health care. This makes EFS an ideal tool to be incorporated into routine preoperative frailty assessment.…”

Section: Discussionmentioning

confidence: 68%

“…[29][30][31] Previous work on the perioperative use of EFS has been focused on its predictability of postoperative mortality and length of hospital stay, but little attention has been given to the exact EFS score that could help with risk stratification in the surgical patients. 11,32,33 Since EFS was developed and assessed by a group of Canadian geriatricians, the standard cut off value used to define frail and nonfrail patients may not be fully applicable when applying to the surgical patients in Asia when predicting postoperative outcomes. 19 Our work demonstrated for the first time that EFS score of 4 and above could give perioperative clinicians fair predictability of increased postoperative complication risk in the Asian patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

Hui

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized frailty assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. Scores ranging from “non-frail” (<=5 points), “vulnerable” (6<=n<=7 points) and “frail” (>=8 points). However, little evaluation of its use has been carried out in the Asians so far. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly Asian patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. Methods This is a prospective observational study done among patients aged 70 years and above attended PAC in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater variability of EFS was also assessed using Bland Altman plot. Results EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement. Conclusion These results show that EFS is able to predict postoperative complications in elderly Asian patients undergoing elective major abdominal surgery. It is also feasible to be incorporated as a standard assessment in the outpatient preoperative clinic setting.

show abstract

“…Previous work on the perioperative use of EFS has been focused on its predictability of postoperative mortality and length of hospital stay, but little attention has been given to the exact EFS score that could help with risk stratification in the surgical population 11,33,34 . Currently, there is no consensus on the use of EFS cut-off scores to define non-frail, vulnerable and frail among the clinicians globally.…”

Section: Discussionmentioning

confidence: 99%

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Hao

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized Frail assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. However, little evaluation of its use has been carried out in the Asian populations so far. This is a prospective observational study done among patients aged 70 years and above attended Preoperative Assessment Clinic (PAC) in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater reliability of EFS was assessed by Kappa statistics and Bland Altman plot. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of both early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement.

show abstract

Frailty as a Predictor of Death or New Disability After Surgery

Abstract: Older people with frailty are significantly more likely to die or experience a new patient-reported disability after surgery. Clinicians performing frailty assessments before surgery should consider the CFS over the mFI as accuracy was similar, but ease of use and feasibility were higher.

Cited by 139 publications

References 34 publications

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Contact Info

Product

Resources

About