Screening for Frailty in Thoracic Surgical Patients

Abstract

Background The presence of frailty or prefrailty in older adults is a risk factor for postsurgical complications. The frailty phenotype can be improved through long-term resistance and aerobic training. It is unknown whether short-term preoperative interventions targeting frailty will help to mitigate surgical risk. The purpose of this study was to determine the proportion of frail and prefrail patients presenting to a thoracic surgical clinic who could benefit from a frailty reduction intervention. Methods A prospective cohort study was performed at a single-site thoracic surgical clinic. Starting October 1, 2014, surgical candidates 60 years of age or older who consented to be screened were included. Patients were screened using an adapted version of Fried’s phenotypic frailty criteria: weakness (grip strength), slow gait (15-foot walk), unintentional weight loss, self-reported exhaustion, and low self-reported physical activity (Physical Activity Scale for the Elderly). Prefrailty was identified when participants demonstrated one to two frailty characteristics; frailty was identified when participants demonstrated three to five frailty characteristics. Results Of 180 eligible patients, 126 consented, and 125 completed screening. Thirty-nine participants (31%) were not frail, 71 (57%) were prefrail, and 15 (12%) were frail. Exhaustion was the most common frailty symptom (34%). Frailty prevalence did not significantly differ among men and women (men: 10%, women: 14%; p = 0.75). Conclusions We found a high proportion of prefrail and frail patients among patients deemed candidates for thoracic surgical procedures. This finding indicates that frailty may be underrecognized. Substantial numbers of patients may be considered for a presurgical frailty reduction intervention.

Delirium in Frail Older Adults

“…They speculated that physicians did not recognize the patient's frailty at the time of referral for surgery. 55 Considering that frailty being a risk factor for delirium, underrecognized frailty among hospitalized older adults can result in a higher incidence of delirium and associated adverse clinical outcomes. Similarly, since delirium may increase the risk of post-operative frailty, early recognition, prevention, and proper management of delirium is also important to provide optimal care for older adults in the hospital.…”

“…Frailty is also easily missed in clinical practice because there is no standardized systematic screening tool, and some measures are not practical to perform in routine clinical settings. 54 ) For example, Beckert et al 55 ) reported frailty in a high proportion of patients (68.8%) deemed to be surgical candidates and referred for surgeries. They speculated that physicians did not recognize a patient’s frailty at the time of referral for surgery.…”

Early-Stage NSCLC: Advances in Thoracic Oncology 2018

“…Multiple investigators have shown the ability to preoperatively identify frail thoracic surgery patients. 48,49 A recent analysis used a combination of grip strength, gait, weight loss, and self-reported exhaustion and activity to identify 12% of thoracic surgery patients as frail and 57% as prefrail. 48 Ongoing trials are evaluating the ability of prehabilitiation to mitigate increased rates of operative morbidity in frail patients.…”

Enhanced Recovery After Surgery

“…12,13 With the aging population and increases in the use of potentially debilitating preoperative systemic therapy, measurement of preoperative frailty is strongly recommended. 14,15 While the factors that define ‘frailty’ have not been precisely defined, clinicopathologic factors such as age, preoperative albumin level, and sarcopenia have been associated with postoperative morbidity. 16–18 Objective and validated measures of functional capacity such as the Timed Up and Go Test, the 6-minute walk test, and measurement of hand grip strength can prove useful for frailty measurement.…”