Frailty index is useful for predicting postoperative morbidity in older patients undergoing gastrointestinal surgery: a prospective cohort study

Abstract

Background Many assessment tools have been used to identify frail surgical patients. This study was designed to explore the prediction value of the frailty index (FI) for postoperative morbidity in older patients undergoing elective gastrointestinal surgery. Methods Between January 2019 and September 2020, we conducted a prospective study in our hospital, and patients aged over 65 years were enrolled. The FI assessment was conducted by two specialist nurses based on the 38-item scale, and patients were considered frail if the FI score was ≥ 0.25. The primary outcome was 30-day postoperative morbidity. Univariable and multivariable analyses were used to find the risk factors related to postoperative morbidity. Results A total of 246 consecutive patients were enrolled, for whom the median age was 72.0 [interquartile range (IQR): 67.0–77.0] years old, and 175 (71.1%) were male. Of these, 47 (19.1%) were frail. Patients with frailty were associated with older age (p < 0.001), higher American Society of Anesthesiologists (ASA) grade (p = 0.006), lower body mass index (p = 0.001), lower albumin (p = 0.003) and haemoglobin (p < 0.001) levels, increased blood loss (p = 0.034), increased risk of postoperative morbidity (p < 0.001), increased median length of stay (p = 0.017), and increased median postoperative hospital stay (p = 0.003). Multivariable analysis revealed that ASA grade [odds ratio (OR): 2.59, 95% confidence interval (CI) 1.19–5.64, p = 0.016], FI score (OR 7.68, 95% CI 3.19–18.48, p < 0.001) and surgical complexity (OR 22.83, 95% CI 5.46–95.51, p < 0.001) were independent predictors of 30-day postoperative morbidity. However, for patients with major surgery, FI score was the only independent predictor (OR 8.67, 95% CI 3.23–23.25, p < 0.001). Conclusion Frailty was associated with adverse perioperative outcomes, and the 38-item FI scale was a useful frailty screening tool for older patients undergoing elective gastrointestinal surgery. For patients with major surgery, frailty was a more reliable predictor of postoperative 30-day morbidity than age and ASA grade.

A retrospective analysis of frailty status on atrial fibrillation catheter ablation outcomes

“…However, the eFI has previously been used and validated in patients undergoing surgical procedures and has been associated with adverse post operative outcomes across a number of surgical specialties. [19][20][21][22] This study contributes to the broader literature on frailty in the cardiovascular field, and highlight's the importance of a comprehensive geriatric assessment in the management of older adults with AF.…”

Outcomes in elderly patients undergoing hepatic resection compared to liver transplant for hepatocellular carcinoma

“…The survival advantage associated with LT persisted even in the matched cohort in our study. Other studies have shown a relatively long 5‐year survival of 66%−70% for elderly patients receiving LTs, compared to the median survival of 10−14 months in patients with early‐stage HCC not receiving any treatment, which conveys a clear survival benefit of an LT 5,17 . Previous studies comparing the early outcomes of LTs in young versus elderly patients did not show any significant difference in rates of vascular or biliary morbidity between the two groups, 17–20 with none of the studies demonstrating age as a predictor of early mortality.…”

“…Other studies have shown a relatively long 5‐year survival of 66%−70% for elderly patients receiving LTs, compared to the median survival of 10−14 months in patients with early‐stage HCC not receiving any treatment, which conveys a clear survival benefit of an LT 5,17 . Previous studies comparing the early outcomes of LTs in young versus elderly patients did not show any significant difference in rates of vascular or biliary morbidity between the two groups, 17–20 with none of the studies demonstrating age as a predictor of early mortality. The rates of the major indicators of postoperative outcome (rates of vascular and biliary complications) are not different irrespective of the age of the liver recipient, and these operations can safely be carried out in an elderly population.…”

Frailty concept in Africa neurosurgical practice: a prospective review

“…Frailty studies have important roles in optimizing neurosurgical outcomes in Africa, as the frailty index was found to be useful in determining perioperative morbidity [24]. It's therefore important that research that focuses on generating a frailty index that will be specific for patients in different neurosurgical facilities across the continent be carried out to serve as guides for neurosurgeons in carefully selecting patients for surgeries and also preoperative counseling and consent taking.…”