Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits

Mirabelli, Luke G.; Cosker, Robert M.; Kraiss, Larry W.; Griffin, Claire L.; Smith, Brigitte K.; Sarfati, Mark R.; Al-Dulaimi, Ragheed; Brooke, Benjamin S.

doi:10.1016/j.avsg.2017.08.010

Cited by 35 publications

(21 citation statements)

References 13 publications

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“…( 12 ) Six studies, in addition to the original validation done in community dwelling outpatients, examined concurrent validity. ( 17 – 21 ) Of these, three had a primary objective of evaluating the reliability of frailty assessment in the ICU; however, none of them explicitly tested agreement with geriatricians based on CGA. ( 17 , 18 , 22 ) Instead, CFS ratings were obtained from chart review rather than direct patient or family contact, ( 18 ) or included only raters without formal training in geriatrics.…”

Section: Introductionmentioning

confidence: 99%

Interrater Reliability of the Clinical Frailty Scale by Geriatrician and Intensivist in Patients Admitted to the Intensive Care Unit

et al. 2020

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Background The Clinical Frailty Scale (CFS) is a commonly used frailty measure in intensive care unit (ICU) settings. We are interested in the test characteristics, especially interrater reliability, of the CFS in ICU by comparing the scores of intensivists to geriatricians. Methods We conducted a prospective cohort study on a convenience sample of newly admitted patients to an ICU in Edmonton, Canada. An intensivist and a resident in Geriatric Medicine (GM) independently assigned a CFS score on 158 adults within 72 hours of admission. A specialist in Geriatric Medicine assigned a CFS score independently of 20 of the 158 patients to assess agreement between the two raters trained in geriatrics. Predictive validity was captured using mortality and length of stay. Results Agreement on CFS score was fair for intensivists vs. GM resident (kappa 0.32) and for intensivists vs. GM specialist (0.29), but substantial for GM resident vs. staff (0.79). Despite this, the CFS remained prognostically relevant, regardless of rater background. Frailty (CFS ≥ 5) as assessed by either intensivist or GM resident was a strong predictor of in-hospital mortality (odds ratio [OR] 3.6; 95% CI, 1.6-8.4, p = .003 and OR 3.0; 95% CI 1.3-6.9; p = .01, respectively). Frailty was also positively correlated with age, illness severity measured by APACHE II score, and length of hospital stay. Conclusions The interrater reliability of the CFS in ICU settings is fair for intensivists vs. geriatricians.

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Section: Introductionmentioning

confidence: 99%

Interrater Reliability of the Clinical Frailty Scale by Geriatrician and Intensivist in Patients Admitted to the Intensive Care Unit

et al. 2020

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“…1,[8][9][10][11][12] A rapid and validated method for preoperative frailty assessment known as the Clinical Frailty Scale (CFS) was recently found to be a highly specific and efficient tool for identifying frail patients in outpatient vascular surgery clinics. 3,13 The CFS has a high inter-rater reliability among different vascular providers and can be assessed in less than a minute. 13 In this study, we sought to evaluate whether a preoperative CFS score could be used to predict loss of independence or mortality after major vascular procedures.…”

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confidence: 99%

“…3,13 The CFS has a high inter-rater reliability among different vascular providers and can be assessed in less than a minute. 13 In this study, we sought to evaluate whether a preoperative CFS score could be used to predict loss of independence or mortality after major vascular procedures.…”

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confidence: 99%

Preoperative frailty assessment predicts loss of independence after vascular surgery

Donald

Ghaffarian

Isaac

et al. 2018

Journal of Vascular Surgery

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Objective: Frailty, a clinical syndrome associated with loss of metabolic reserves, is prevalent among patients who present to vascular surgery clinics for evaluation. The Clinical Frailty Scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures. Methods: We identified all patients living independently at home who were prospectively assessed using the CFS before undergoing an elective major vascular surgery procedure (admitted for >24 hours) at an academic medical center between December 2015 and December 2017. Patient-and procedure-level clinical data were obtained from our institutional Vascular Quality Initiative registry database. The composite outcome of discharge to a nonhome location or 30-day mortality was evaluated using bivariate and multivariate regression models. Results: A total of 134 independent patients were assessed using the CFS before they underwent elective open abdominal aortic aneurysm repair (8%), endovascular aneurysm repair (26%), thoracic endovascular aortic repair (6%), suprainguinal bypass (6%), infrainguinal bypass (16%), carotid endarterectomy (19%), or peripheral vascular intervention (20%). Among 39 (29%) individuals categorized as being frail using the CFS, there was no significant difference in age or American Society of Anesthesiologists physical status compared with nonfrail patients. However, frail patients were significantly more likely to need mobility assistance after surgery (62% frail vs 22% nonfrail; P < .01) and to be discharged to a nonhome location (22% frail vs 6% nonfrail; P ¼ .01) or to die within 30 days after surgery (8% frail vs 0% nonfrail; P < .01). Preoperative frailty was associated with a >12-fold higher risk (odds ratio, 12.1; 95% confidence interval, 2.17-66.96; P < .01) of 30-day mortality or loss of independence, independent of the vascular procedure undertaken. Conclusions: The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective major vascular surgery and can be used to predict likelihood of requiring discharge to a nursing facility or death after surgery. The identification of frail patients before major surgery can help manage postoperative expectations and optimize transitions of care.

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“…The CFS is a validated frailty assessment tool that classifies frailty on a 9-point scale, ranging from being ''very fit'' (1 point) to ''vulnerable'' (4 points), ''mildly frail'' (5 points), ''severely frail'' (7 points), and ''terminally ill'' (9 points) (Table I). 10,11 This CFS score incorporates an assessment of the patient's functional status, cognition, mobility, and number of comorbidities. After completing this assessment of frailty, the CFS score was entered into the patient's electronic health record.…”

Section: Exposure Groups: Frailty and Surgical Stressmentioning

confidence: 99%

Long-Term Impact of Vascular Surgery Stress on Frail Older Patients

Gilbertson

Bailey

Kraiss

et al. 2021

Annals of Vascular Surgery

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Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits

Cited by 35 publications

References 13 publications

Interrater Reliability of the Clinical Frailty Scale by Geriatrician and Intensivist in Patients Admitted to the Intensive Care Unit

Interrater Reliability of the Clinical Frailty Scale by Geriatrician and Intensivist in Patients Admitted to the Intensive Care Unit

Preoperative frailty assessment predicts loss of independence after vascular surgery

Long-Term Impact of Vascular Surgery Stress on Frail Older Patients

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