Frailty Related to Anesthesia guided by the Index “bispectraL” (FRAIL) study: study protocol for a randomized controlled trial

Abstract

Background: Currently, patients older than 60 years of age represent 25% of the population and are at an increased risk during surgery. Therefore, reducing postoperative morbidity and mortality is a major concern in medical research and practice. Dependence on caregivers and cognitive impairment represent two major risk factors in the elderly, especially in frail patients after surgery under general anesthesia. In this context, continuous monitoring of the depth of anesthesia using a bispectral index (BIS) sensor may reduce the occurrence of impairments by gaining better control of the anesthetic depth. The first aim of this study is to compare manual versus automated administration of intravenous anesthetics with regard to 6-month functional decline in persons aged 70 years and older. The secondary objective includes an evaluation of the influence of the frail phenotype on self-sufficiency in elderly patients after general anesthesia. Methods/design: After receiving ethical committee approval and written consent, a complete preoperative assessment of physiological reserve and self-sufficiency will be performed on patients more than 70 years old who are scheduled for surgery under general anesthesia. This evaluation will determine the patient's frailty status in three categories: robust, pre-frail, and frail. Then, patients will be randomized into two groups: manual administration of anesthetics guided by BIS sensor (manual group) or automated administration (automated group) with recording of the anesthesia. A second examination will be scheduled after 6 months to assess changes in functional abilities, cognitive functions, and frailty status. A priori calculation of sample size gives a population of 430 patients to be included in this multicenter trial.Discussion: This clinical study is designed to detect any postoperative complications and deaths related to the performance of the general anesthesia guided by the BIS sensor and the preoperative functional status of the elderly: robust, pre-frail, or frail.

Can the Tilburg Frailty Indicator predict post-operative quality of recovery in patients with gynecologic cancer? A prospective cohort study

“…A range of various frailty scales are being increasingly used to assess patients peri-operatively. Investigators previously ascertained that frailty was connected to an increased rate of adverse outcomes such as post-operative complications, prolonged length of stay, and increased hospital resource utilization 9 10. Runner et al28 described the mFI as an effective method to predict post-operative complications, re-admission, and 30-day mortality in patients with primary total knee arthroplasty.…”

“…Frailty can be evaluated objectively with a series of tools that include the Frailty Index, the modified Frailty Index (mFI), and the Fried Frailty Score. Although an increasing number of studies have focused on the association between pre-operative frailty assessment and post-operative outcome, conclusions are inconsistent9–12 and there is still no uniform frailty assessment tool that applies to the peri-operative period 13 14. A meta-analysis showed an incidence of complications in frail patients that was significantly higher than that in non-frail patients 10.…”